Healthcare Provider Details

I. General information

NPI: 1750687638
Provider Name (Legal Business Name): LISA PHUONG HOANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 540
MISSION VIEJO CA
92691-6384
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY STE 540
MISSION VIEJO CA
92691-6384
US

V. Phone/Fax

Practice location:
  • Phone: 949-242-6915
  • Fax:
Mailing address:
  • Phone: 949-242-6915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA115324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: