Provider Demographics
NPI:1568771632
Name:TRI-DUNG G. HOANG MD, INC.
Entity Type:Organization
Organization Name:TRI-DUNG G. HOANG MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRI-DUNG
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-391-0170
Mailing Address - Street 1:6540 STOCKTON BLVD STE 3A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1635
Mailing Address - Country:US
Mailing Address - Phone:916-391-0170
Mailing Address - Fax:916-391-0442
Practice Address - Street 1:6540 STOCKTON BLVD STE 3A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1635
Practice Address - Country:US
Practice Address - Phone:916-391-0170
Practice Address - Fax:916-391-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568771632Medicaid
CAFM024AMedicare PIN