Healthcare Provider Details

I. General information

NPI: 1578057717
Provider Name (Legal Business Name): JENNIFER ND HOANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 ELM AVE STE 108
LONG BEACH CA
90806-1600
US

IV. Provider business mailing address

18664 BUSHARD ST
FOUNTAIN VALLEY CA
92708-7209
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-5409
  • Fax:
Mailing address:
  • Phone: 714-262-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34084TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT34084TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: