Healthcare Provider Details

I. General information

NPI: 1952397937
Provider Name (Legal Business Name): KHANG VICTOR HOANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KHANG VICTOR HOANG D.O.

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13672 HAWTHORNE BLVD
HAWTHORNE CA
90250-5810
US

IV. Provider business mailing address

13672 HAWTHORNE BLVD
HAWTHORNE CA
90250-5810
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-5097
  • Fax: 310-644-5408
Mailing address:
  • Phone: 310-644-5097
  • Fax: 310-644-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5883
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A5883
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A5883
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A5883
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A5883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: