Provider Demographics
NPI:1700935814
Name:HOANG, THIEUHA TUAN (MD)
Entity Type:Individual
Prefix:
First Name:THIEUHA
Middle Name:TUAN
Last Name:HOANG
Suffix:
Gender:F
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:PO BOX 128
Mailing Address - Street 2:E-47 MEDICAL
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92674-0128
Mailing Address - Country:US
Mailing Address - Phone:714-978-7488
Mailing Address - Fax:
Practice Address - Street 1:300 S HARBOR BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3733
Practice Address - Country:US
Practice Address - Phone:714-978-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97879261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center