Healthcare Provider Details

I. General information

NPI: 1194195693
Provider Name (Legal Business Name): TERESA V HOANG-WU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 11/29/2021
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W SUNSET BLVD
LOS ANGELES CA
90027-6082
US

IV. Provider business mailing address

24771 HENDON ST
LAGUNA HILLS CA
92653-4635
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-9005
  • Fax:
Mailing address:
  • Phone: 949-357-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA160482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: