Provider Demographics
NPI:1508828724
Name:HOANG, THANH KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:KIM
Last Name:HOANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11210 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 126-A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2528
Mailing Address - Country:US
Mailing Address - Phone:281-564-2900
Mailing Address - Fax:281-564-0800
Practice Address - Street 1:11210 BELLAIRE BLVD STE 126A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2528
Practice Address - Country:US
Practice Address - Phone:281-564-2900
Practice Address - Fax:281-564-0800
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018083801Medicaid
TX113793701Medicaid
TXTX145754OtherMEDICARE