Provider Demographics
NPI:1871792796
Name:HOANG, THIEN-AN (MD)
Entity type:Individual
Prefix:
First Name:THIEN-AN
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:636-561-4100
Mailing Address - Fax:636-561-8445
Practice Address - Street 1:200 MEDICAL PLZ
Practice Address - Street 2:STE 101
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1379
Practice Address - Country:US
Practice Address - Phone:636-561-4100
Practice Address - Fax:636-561-8445
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013041288207Q00000X, 207Q00000X
FLME70688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124510083Medicare PIN