Provider Demographics
NPI:1952428161
Name:HOANG, MINH TAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINH
Middle Name:TAT
Last Name:HOANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14633 RIO RANCHO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3638
Mailing Address - Country:US
Mailing Address - Phone:619-847-3677
Mailing Address - Fax:
Practice Address - Street 1:5955 MIRA MESA BLVD BLDG C SUITE E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4304
Practice Address - Country:US
Practice Address - Phone:858-558-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist