Provider Demographics
NPI:1689747222
Name:JACQUELINE K. HOANG MD PC
Entity Type:Organization
Organization Name:JACQUELINE K. HOANG MD PC
Other - Org Name:PEDIATRIC ASSOCIATES OF SPRINGFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-642-8306
Mailing Address - Street 1:5502 BACKLICK RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3904
Mailing Address - Country:US
Mailing Address - Phone:703-642-8306
Mailing Address - Fax:703-642-8342
Practice Address - Street 1:5502 BACKLICK RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3904
Practice Address - Country:US
Practice Address - Phone:703-642-8306
Practice Address - Fax:703-642-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053611208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG43239Medicare UPIN