Provider Demographics
NPI:1306446984
Name:HOANG, HUNG JOHN
Entity type:Individual
Prefix:
First Name:HUNG
Middle Name:JOHN
Last Name:HOANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WACHUSETT RD
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02191-1121
Mailing Address - Country:US
Mailing Address - Phone:781-985-6355
Mailing Address - Fax:
Practice Address - Street 1:301 FALLS BLVD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8160
Practice Address - Country:US
Practice Address - Phone:617-745-4393
Practice Address - Fax:617-745-4395
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist