Provider Demographics
NPI:1598283707
Name:HOANG, JANICE MAI NGOC (PA-C)
Entity Type:Individual
Prefix:
First Name:JANICE MAI
Middle Name:NGOC
Last Name:HOANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NGOC-MAI
Other - Middle Name:THI
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4813 E PEMBROOK CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2051 E MARY ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3617
Practice Address - Country:US
Practice Address - Phone:620-765-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant