MEDICARE: NGOC-YEN THI HOANG OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11650	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9840834	OTHER	CA	MEDICAL PIN

General Provider Information

NPI Number	:	1609993682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGOC-YEN THI HOANG OD

Provider Business Mailing Address
First Line	:	500 E WILKEN WAY
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92802-4946
Country	:	US
Telephone Number	:	714-501-1009
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 E SOUTH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4521
Country	:	US
Telephone Number	:	562-790-2460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	03/17/2018

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