Provider Demographics
NPI:1609677616
Name:HOANG, HOAN N
Entity type:Individual
Prefix:MR
First Name:HOAN
Middle Name:N
Last Name:HOANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ALLEN
Other - Middle Name:N
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8811 SHASTA LILY DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3895
Mailing Address - Country:US
Mailing Address - Phone:916-271-1952
Mailing Address - Fax:
Practice Address - Street 1:8811 SHASTA LILY DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-3895
Practice Address - Country:US
Practice Address - Phone:916-271-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97440225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty