Healthcare Provider Details

I. General information

NPI: 1881838530
Provider Name (Legal Business Name): UYEN BAO HOANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 E BALL RD STE C
ANAHEIM CA
92806-5159
US

IV. Provider business mailing address

2035 E BALL RD STE C
ANAHEIM CA
92806-5159
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-6100
  • Fax: 714-517-6139
Mailing address:
  • Phone: 714-517-6100
  • Fax: 714-517-6139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA107126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: