Healthcare Provider Details

I. General information

NPI: 1497054258
Provider Name (Legal Business Name): KEVIN HOANG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2011
Last Update Date: 06/10/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCAS YUMA BLDG #1175
YUMA AZ
85365
US

IV. Provider business mailing address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 928-269-3177
  • Fax:
Mailing address:
  • Phone: 928-269-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2013019221
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: