Healthcare Provider Details

I. General information

NPI: 1306272190
Provider Name (Legal Business Name): TEA HUYEN HOANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 07/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N GLASSELL ST
ORANGE CA
92867-3628
US

IV. Provider business mailing address

1330 N GLASSELL ST
ORANGE CA
92867-3628
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-9614
  • Fax: 714-633-9617
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: