Provider Demographics
NPI:1114212081
Name:HOANG, SOOK C (MD)
Entity Type:Individual
Prefix:
First Name:SOOK
Middle Name:C
Last Name:HOANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOOK
Other - Middle Name:CHAN
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26 GROTTO AVE
Mailing Address - Street 2:APARTMENT 2L
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5557
Mailing Address - Country:US
Mailing Address - Phone:267-304-3713
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-4923
Practice Address - Country:US
Practice Address - Phone:434-243-3090
Practice Address - Fax:434-244-9445
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249232208600000X
RILP03660208C00000X
VA0101262765208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery