Healthcare Provider Details

I. General information

NPI: 1225969637
Provider Name (Legal Business Name): HANNAH KIM HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11799 SEBASTIAN WAY STE 103
RANCHO CUCAMONGA CA
91730-0708
US

IV. Provider business mailing address

15750 AVENIDA DE CALMA
MORENO VALLEY CA
92555-4232
US

V. Phone/Fax

Practice location:
  • Phone: 951-807-1142
  • Fax:
Mailing address:
  • Phone: 951-807-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: