Provider Demographics
NPI:1083150759
Name:HOANG, THIEU-KHA
Entity Type:Individual
Prefix:
First Name:THIEU-KHA
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11072 W OCEAN AIR DR APT 235
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4606
Mailing Address - Country:US
Mailing Address - Phone:831-241-1723
Mailing Address - Fax:
Practice Address - Street 1:1550 LEUCADIA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2371
Practice Address - Country:US
Practice Address - Phone:760-704-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist