Provider Demographics
NPI:1437307030
Name:HOANG, HAIDANG (DO)
Entity Type:Individual
Prefix:DR
First Name:HAIDANG
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:2028 US HIGHWAY 92 W
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3921
Practice Address - Country:US
Practice Address - Phone:863-965-9327
Practice Address - Fax:863-968-9058
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56632-21207Q00000X
FLOS10588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020632000Medicaid
FLDJ869ZMedicare PIN
FLDJ869YMedicare PIN