Bao Xuan Hoang, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9113574 Issued in FL

Practice address

1049 S State Road 7
Wellington, FL 33414-6135

Phone

(561) 250-7047

NPI assigned

Nov 12, 2020

Last updated

Oct 19, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1063014298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 S STATE ROAD 7",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334146135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 S STATE ROAD 7",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334146135",
            "telephone_number": "561-250-7047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4850 Millenia Blvd",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328396012",
            "country_code": "US",
            "telephone_number": "407-264-5601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOANG",
        "first_name": "BAO",
        "middle_name": "XUAN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-12",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9113574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL DEPARTMENT OF HEALTH PA LICENSE",
            "identifier": "9113574",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Wellington, FL
• Providers in Wellington, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.