Provider Demographics
NPI:1962461020
Name:HOANG, HUY KIM (MD)
Entity Type:Individual
Prefix:
First Name:HUY
Middle Name:KIM
Last Name:HOANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10530 BOLSA AVENUE
Mailing Address - Street 2:STE C
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-554-4676
Mailing Address - Fax:714-554-9007
Practice Address - Street 1:10530 BOLSA AVENUE
Practice Address - Street 2:STE C
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-554-4676
Practice Address - Fax:714-554-9007
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F41923Medicare UPIN
A049463Medicare ID - Type Unspecified