Provider Demographics
NPI:1700870698
Name:HOANG, PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 BELLAIRE BLVD
Mailing Address - Street 2:SUITE C31
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2536
Mailing Address - Country:US
Mailing Address - Phone:281-988-8999
Mailing Address - Fax:281-988-9990
Practice Address - Street 1:11209 BELLAIRE BLVD
Practice Address - Street 2:SUITE C31
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2536
Practice Address - Country:US
Practice Address - Phone:281-988-8999
Practice Address - Fax:281-988-9990
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4588111N00000X
TX26657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-564-287-1OtherECFMG
TXC06020025Medicaid
TXU14203Medicare UPIN
TXC06020025Medicaid