Healthcare Provider Details

I. General information

NPI: 1811283484
Provider Name (Legal Business Name): KENNETH HOANG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24541 PACIFIC PARK DR SUITE 290
ALISO VIEJO CA
92656-3065
US

IV. Provider business mailing address

24541 PACIFIC PARK DR STE 290
ALISO VIEJO CA
92656-3058
US

V. Phone/Fax

Practice location:
  • Phone: 949-448-8599
  • Fax:
Mailing address:
  • Phone: 949-448-8599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: