Provider Demographics
NPI:1831209303
Name:HOANG, NAM NGOC (DMD)
Entity type:Individual
Prefix:DR
First Name:NAM
Middle Name:NGOC
Last Name:HOANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:OETER
Other - Middle Name:NGOC
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:9029 RESEDA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3932
Mailing Address - Country:US
Mailing Address - Phone:818-701-9700
Mailing Address - Fax:818-337-3044
Practice Address - Street 1:9029 RESEDA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3932
Practice Address - Country:US
Practice Address - Phone:818-701-9700
Practice Address - Fax:818-337-3044
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice