Provider Demographics
NPI:1588696223
Name:HOANG, TU (MD)
Entity type:Individual
Prefix:
First Name:TU
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17118 FIRST LIGHT LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8708
Mailing Address - Country:US
Mailing Address - Phone:909-883-2394
Mailing Address - Fax:
Practice Address - Street 1:1881 COMMERCENTER E
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3456
Practice Address - Country:US
Practice Address - Phone:909-388-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00310658OtherRAILROAD MEDICARE PIN
CA00A799620Medicaid
CA00A799621Medicare ID - Type Unspecified
CAH71497Medicare UPIN