Provider Demographics
NPI:1437459823
Name:HUNG G HOANG MD INCORPORATED
Entity Type:Organization
Organization Name:HUNG G HOANG MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:GIA
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-858-8515
Mailing Address - Street 1:2001 ZINFANDEL DR
Mailing Address - Street 2:SUITE B2
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4265
Mailing Address - Country:US
Mailing Address - Phone:916-858-8515
Mailing Address - Fax:916-858-8246
Practice Address - Street 1:2001 ZINFANDEL DR
Practice Address - Street 2:SUITE B2
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4265
Practice Address - Country:US
Practice Address - Phone:916-858-8515
Practice Address - Fax:916-858-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A363710Medicaid
CA00A363710Medicaid
CAA28059Medicare UPIN