Healthcare Provider Details

I. General information

NPI: 1144901745
Provider Name (Legal Business Name): JENNY HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRISTOL ST STE A205
COSTA MESA CA
92626-5951
US

IV. Provider business mailing address

13181 LAMPSON AVE SPC 506
GARDEN GROVE CA
92840-6139
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-0484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: