Healthcare Provider Details

I. General information

NPI: 1932552049
Provider Name (Legal Business Name): LY HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7191 WARNER AVE
HUNTINGTON BEACH CA
92647-5429
US

IV. Provider business mailing address

16194 REDWOOD ST
FOUNTAIN VALLEY CA
92708-1512
US

V. Phone/Fax

Practice location:
  • Phone: 714-841-5118
  • Fax: 714-375-4333
Mailing address:
  • Phone: 714-841-5118
  • Fax: 714-375-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: