Provider Demographics
NPI:1629600093
Name:HOANG, THANH
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W GARY ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7599
Mailing Address - Country:US
Mailing Address - Phone:918-688-4846
Mailing Address - Fax:
Practice Address - Street 1:2448 W NEW ORLEANS ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1590
Practice Address - Country:US
Practice Address - Phone:918-286-4980
Practice Address - Fax:918-286-4970
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC8114372600000X, 374U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHC8114OtherSTATE OF OKLAHOMA DEPT OF HEALTH LICENSE NUMBER