Healthcare Provider Details

I. General information

NPI: 1912628538
Provider Name (Legal Business Name): JONLENE QUOC HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25965 NORMANDIE AVE
HARBOR CITY CA
90710-3416
US

IV. Provider business mailing address

15215 OSAGE AVE
LAWNDALE CA
90260-1704
US

V. Phone/Fax

Practice location:
  • Phone: 866-352-1314
  • Fax:
Mailing address:
  • Phone: 424-210-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: