Healthcare Provider Details

I. General information

NPI: 1922141464
Provider Name (Legal Business Name): MICHAEL D. HOANG ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E. ARTESIA BLVD
COMPTON CA
90221-2608
US

IV. Provider business mailing address

17112 CRENSHAW BLVD
TORRANCE CA
90504-2608
US

V. Phone/Fax

Practice location:
  • Phone: 310-763-3479
  • Fax:
Mailing address:
  • Phone: 310-515-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: