Healthcare Provider Details

I. General information

NPI: 1538956321
Provider Name (Legal Business Name): JONATHAN HOANG DDS PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20106 PIONEER BLVD STE A
CERRITOS CA
90703-7400
US

IV. Provider business mailing address

20106 PIONEER BLVD STE A
CERRITOS CA
90703-7400
US

V. Phone/Fax

Practice location:
  • Phone: 562-926-6643
  • Fax:
Mailing address:
  • Phone: 562-926-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: COLLIN TSAI
Title or Position: VICE PRESIDENT
Credential:
Phone: 415-794-4279