Healthcare Provider Details

I. General information

NPI: 1154762151
Provider Name (Legal Business Name): AI-CHAU HOANG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 S. AVALON BLVD STE. 225
CARSON CA
90745
US

IV. Provider business mailing address

21601 S. AVALON BLVD STE. 225
CARSON CA
90745
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-4080
  • Fax: 657-276-4740
Mailing address:
  • Phone: 657-241-4080
  • Fax: 657-276-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: