MEDICARE: THAO YEN HOANG D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	20A6854	CA

General Provider Information

NPI Number	:	1750348363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAO YEN HOANG D.O.

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 LAKEWOOD BLVD STE C
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2412
Country	:	US
Telephone Number	:	562-361-5671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	12/17/2025

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