Provider Demographics
NPI:1164486296
Name:HOANG, RICHARD THAO (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:THAO
Last Name:HOANG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12462 PUTNAM ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1049
Mailing Address - Country:US
Mailing Address - Phone:562-789-5444
Mailing Address - Fax:562-789-4449
Practice Address - Street 1:12462 PUTNAM ST STE 500
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602
Practice Address - Country:US
Practice Address - Phone:562-789-5444
Practice Address - Fax:562-789-4449
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16711363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G471930Medicaid
CAP92240Medicare UPIN
CAWPA16711BMedicare ID - Type UnspecifiedMEDICARE PPIN