Provider Demographics
NPI:1366445413
Name:HOANG, THUY THU (MD)
Entity Type:Individual
Prefix:DR
First Name:THUY
Middle Name:THU
Last Name:HOANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2593 S KING RD
Mailing Address - Street 2:STE 7
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1880
Mailing Address - Country:US
Mailing Address - Phone:408-238-7390
Mailing Address - Fax:408-238-7395
Practice Address - Street 1:2593 S KING RD
Practice Address - Street 2:STE 7
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1880
Practice Address - Country:US
Practice Address - Phone:408-238-7390
Practice Address - Fax:408-238-7395
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
CAG077533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4713530Medicaid
CA00G775330Medicaid
CAG21703Medicare UPIN