Healthcare Provider Details

I. General information

NPI: 1770366957
Provider Name (Legal Business Name): HA HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7526 MONTEREY ST
GILROY CA
95020-5826
US

IV. Provider business mailing address

7526 MONTEREY ST
GILROY CA
95020-5826
US

V. Phone/Fax

Practice location:
  • Phone: 408-848-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: