Healthcare Provider Details

I. General information

NPI: 1790995843
Provider Name (Legal Business Name): MIMI LEE HOANG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7891 LA TIJERA BLVD
LOS ANGELES CA
90045-3145
US

IV. Provider business mailing address

8821 AVIATION BLVD UNIT 88753
LOS ANGELES CA
90009-3769
US

V. Phone/Fax

Practice location:
  • Phone: 213-207-6464
  • Fax:
Mailing address:
  • Phone: 213-207-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: