Healthcare Provider Details

I. General information

NPI: 1427826601
Provider Name (Legal Business Name): KATIE PHUONG HO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E YORBA LINDA BLVD STE 3
PLACENTIA CA
92870-3006
US

IV. Provider business mailing address

7431 EDINGER AVE UNIT 307
HUNTINGTON BEACH CA
92647-7850
US

V. Phone/Fax

Practice location:
  • Phone: 714-996-1212
  • Fax:
Mailing address:
  • Phone: 714-591-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: