Healthcare Provider Details

I. General information

NPI: 1336729623
Provider Name (Legal Business Name): TIFFANY HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 WARNER AVENUE
FOUNTAIN VALLEY CA
92708-3720
US

IV. Provider business mailing address

11420 WARNER AVENUE
FOUNTAIN VALLEY CA
92708-3720
US

V. Phone/Fax

Practice location:
  • Phone: 714-549-1300
  • Fax: 714-433-3100
Mailing address:
  • Phone: 714-549-1300
  • Fax: 714-433-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA59649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: