Healthcare Provider Details

I. General information

NPI: 1255128344
Provider Name (Legal Business Name): KIMVI CAO HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMVI HOANG PHARMD

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 KATELLA AVE
CYPRESS CA
90630-2052
US

IV. Provider business mailing address

5172 DEL SOL CIR
LA PALMA CA
90623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 763-361-4921
  • Fax:
Mailing address:
  • Phone: 562-552-2596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: