Provider Demographics
NPI:1104093327
Name:TO, NGUYEN HOANG (IDC)
Entity type:Individual
Prefix:
First Name:NGUYEN
Middle Name:HOANG
Last Name:TO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS CURTIS WILBUR DDG 54
Mailing Address - Street 2:MEDICAL
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96683-1272
Mailing Address - Country:US
Mailing Address - Phone:1714-362-7835
Mailing Address - Fax:
Practice Address - Street 1:USS CURTIS WILBUR DDG 54
Practice Address - Street 2:MEDICAL
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96683-1272
Practice Address - Country:US
Practice Address - Phone:1714-378-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman