Provider Demographics
NPI:1134434160
Name:HOANG, PHUONG KIM
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:KIM
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 1:30 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-3509
Mailing Address - Country:US
Mailing Address - Phone:609-340-8308
Mailing Address - Fax:
Practice Address - Street 1:30 N ALBANY AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-3509
Practice Address - Country:US
Practice Address - Phone:609-340-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03085900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist