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NPI Code Detail

MEDICARE: KELLEY HOANG

MEDICARE: KELLEY HOANG
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
11223G0001XGeneral Practice Dentistry057374-1NY

General Provider Information

NPI Number : 1801298823
Entity Type Code : Organization
Provider Name (Legal Business Name) : KELLEY HOANG
Provider Business Mailing Address
First Line : 32 THOMPSON ST
Second Line : APT 10
City : NEW YORK
State : NY
Zip : 10013-1645
Country : US
Telephone Number : 714-345-4253
Fax Number :
Provider Business Practice Location Address
First Line : 2020 CORTELYOU RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-5904
Country : US
Telephone Number : 718-703-2020
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : KELLEY THU HOANG
Credential : DDS
Telephone Number : 714-345-4253
Provider Enumeration Date : 09/22/2014
Last Update Date : 09/22/2014

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