Provider Demographics
NPI:1528153350
Name:HOANG, TUAN A (MEDICAL DOCTOR)
Entity type:Individual
Prefix:
First Name:TUAN
Middle Name:A
Last Name:HOANG
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 JACKSON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133
Mailing Address - Country:US
Mailing Address - Phone:415-397-5660
Mailing Address - Fax:415-397-7461
Practice Address - Street 1:890 JACKSON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4867
Practice Address - Country:US
Practice Address - Phone:415-397-5660
Practice Address - Fax:415-397-7461
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35049208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35049Medicaid
CAA27668Medicare UPIN
CAA35049Medicare ID - Type Unspecified