Healthcare Provider Details

I. General information

NPI: 1942350764
Provider Name (Legal Business Name): MICHELL MAI HOANG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39400 PASEO PADRE PKWY
FREMONT CA
94538-2310
US

IV. Provider business mailing address

1239 GINGERWOOD DR
MILPITAS CA
95035-2429
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-3033
  • Fax:
Mailing address:
  • Phone: 408-942-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: