Provider Demographics
NPI:1215018783
Name:TIEU, HOANG D (MD)
Entity Type:Individual
Prefix:
First Name:HOANG
Middle Name:D
Last Name:TIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3812
Mailing Address - Country:US
Mailing Address - Phone:559-255-6476
Mailing Address - Fax:559-255-7906
Practice Address - Street 1:4929 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3812
Practice Address - Country:US
Practice Address - Phone:559-255-6476
Practice Address - Fax:559-255-7906
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA534382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A534380Medicaid
G16103Medicare UPIN
CA00A534380Medicaid