MEDICARE: MAI VI HA HOANG MD

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	207Q00000X	Family Medicine Physician	21554	NV
2	208M00000X	Hospitalist Physician	21554	NV
3	207Q00000X	Family Medicine Physician	MD60544454	WA

General Provider Information

NPI Number	:	1760745988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI VI HA HOANG MD

Provider Business Mailing Address
First Line	:	6870 S RAINBOW BLVD STE 106-107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6870 S RAINBOW BLVD STE 106-107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2106
Country	:	US
Telephone Number	:	253-426-6341
Fax Number	:

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	12/10/2024

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Directions to “ MAI VI HA HOANG MD” Practice Location

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