Provider Demographics
NPI:1043611700
Name:LE-NGUYEN, HOANG
Entity Type:Individual
Prefix:
First Name:HOANG
Middle Name:
Last Name:LE-NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:404 CRANE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3082
Mailing Address - Country:US
Mailing Address - Phone:703-389-4679
Mailing Address - Fax:
Practice Address - Street 1:404 CRANE LN
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3082
Practice Address - Country:US
Practice Address - Phone:703-389-4679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist