MEDICARE: THIEN-AN HOANG M.D

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	2013041288	MO

General Provider Information

NPI Number	:	1871792796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIEN-AN HOANG M.D

Provider Business Mailing Address
First Line	:	PO BOX 23340
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63156-3340
Country	:	US
Telephone Number	:	636-561-4100
Fax Number	:	636-561-8445

Provider Business Practice Location Address
First Line	:	200 MEDICAL PLZ
Second Line	:	STE 101
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-1379
Country	:	US
Telephone Number	:	636-561-4100
Fax Number	:	636-561-8445

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	02/18/2015

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Directions to “ THIEN-AN HOANG M.D” Practice Location

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