Healthcare Provider Details

I. General information

NPI: 1437738903
Provider Name (Legal Business Name): JENNY LAP HOANG CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 04/03/2021
Certification Date: 04/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W MAIN ST STE 108
ALHAMBRA CA
91801-3362
US

IV. Provider business mailing address

7941 HILL DR
ROSEMEAD CA
91770-4124
US

V. Phone/Fax

Practice location:
  • Phone: 626-643-2003
  • Fax:
Mailing address:
  • Phone: 626-643-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number43024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: