Provider Demographics
NPI:1629728050
Name:HOANG, NAOMI THAO
Entity Type:Individual
Prefix:MISS
First Name:NAOMI
Middle Name:THAO
Last Name:HOANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 152ND AVE NE UNIT 732
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5798
Mailing Address - Country:US
Mailing Address - Phone:512-569-2785
Mailing Address - Fax:
Practice Address - Street 1:2911 2ND AVE STE 106
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-5120
Practice Address - Country:US
Practice Address - Phone:206-294-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE613223161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice