Provider Demographics
NPI:1093241713
Name:HOANG, HUONG THIEN (LAC)
Entity Type:Individual
Prefix:
First Name:HUONG
Middle Name:THIEN
Last Name:HOANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:THIENY
Other - Middle Name:
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:365 HANOVER AVE
Mailing Address - Street 2:#207
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5601
Mailing Address - Country:US
Mailing Address - Phone:510-408-8855
Mailing Address - Fax:
Practice Address - Street 1:3735 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1505
Practice Address - Country:US
Practice Address - Phone:510-560-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17567171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist