Healthcare Provider Details

I. General information

NPI: 1679365068
Provider Name (Legal Business Name): AUDREY HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 MARINA VILLAGE PKWY
ALAMEDA CA
94501-6427
US

IV. Provider business mailing address

3164 54TH ST
SAN DIEGO CA
92105-3702
US

V. Phone/Fax

Practice location:
  • Phone: 510-418-5094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: