Provider Demographics
NPI:1588727861
Name:HOANG, BAO BIANCA (DPT, PT)
Entity type:Individual
Prefix:MS
First Name:BAO BIANCA
Middle Name:
Last Name:HOANG
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 AUWAI ST APT A
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5613
Mailing Address - Country:US
Mailing Address - Phone:808-382-9374
Mailing Address - Fax:808-230-2375
Practice Address - Street 1:13811 BLUE VISTA DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2076
Practice Address - Country:US
Practice Address - Phone:808-388-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000259549Medicare UPIN