Healthcare Provider Details

I. General information

NPI: 1023817848
Provider Name (Legal Business Name): QUOC HOA HOANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16051 KASOTA RD
APPLE VALLEY CA
92307-2215
US

IV. Provider business mailing address

13326 RACIMO ST
VICTORVILLE CA
92392-8939
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-4238
  • Fax:
Mailing address:
  • Phone: 760-686-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number56073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: