Healthcare Provider Details

I. General information

NPI: 1609993682
Provider Name (Legal Business Name): NGOC-YEN THI HOANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 E SOUTH ST
LONG BEACH CA
90805-4521
US

IV. Provider business mailing address

500 E WILKEN WAY
ANAHEIM CA
92802-4946
US

V. Phone/Fax

Practice location:
  • Phone: 562-790-2460
  • Fax:
Mailing address:
  • Phone: 714-501-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: