Provider Demographics
NPI:1710034848
Name:TUE NGOC HOANG
Entity type:Organization
Organization Name:TUE NGOC HOANG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:P
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-775-6301
Mailing Address - Street 1:9972 BOLSA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6069
Mailing Address - Country:US
Mailing Address - Phone:714-775-6301
Mailing Address - Fax:714-775-0891
Practice Address - Street 1:9972 BOLSA AVE STE 103
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6069
Practice Address - Country:US
Practice Address - Phone:714-775-6301
Practice Address - Fax:714-775-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY355653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA355650Medicaid
CAPHA355650Medicaid