1356596241 NPI number — HAO HOANG

Table of content: (NPI 1356596241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356596241 NPI number — HAO HOANG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAO HOANG
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAGUNA MEDICAL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356596241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9390 BIG HORN BLVD
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95758-7978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9390 BIG HORN BLVD
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95758-7978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-684-9922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOANG
Authorized Official First Name:
HAO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
916-529-6722

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY49263 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5633133 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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