Healthcare Provider Details

I. General information

NPI: 1659006302
Provider Name (Legal Business Name): SYDNEY HOANG OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E COMMONWEALTH AVE
FULLERTON CA
92831-4026
US

IV. Provider business mailing address

PO BOX 1806
DURHAM NC
27702-1806
US

V. Phone/Fax

Practice location:
  • Phone: 714-441-2636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: