Provider Demographics
NPI:1487957270
Name:HOANG KIM DO MD PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:HOANG KIM DO MD PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PLASTIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:HOANG
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-866-9991
Mailing Address - Street 1:900 CAMERON CIR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1848 SARATOGA AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6612
Practice Address - Country:US
Practice Address - Phone:408-866-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82778261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty