Provider Demographics
NPI:1649915307
Name:HOANG, TIEN (DMD)
Entity type:Individual
Prefix:
First Name:TIEN
Middle Name:
Last Name:HOANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 ORCAS PL NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-6316
Mailing Address - Country:US
Mailing Address - Phone:228-437-5263
Mailing Address - Fax:
Practice Address - Street 1:17420 SOUTHCENTER PKWY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3701
Practice Address - Country:US
Practice Address - Phone:253-395-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11812122300000X
MS4389-23122300000X
WI6001294-15122300000X
WA61305709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist