Healthcare Provider Details

I. General information

NPI: 1124743380
Provider Name (Legal Business Name): PHUONG ANH HOANG LIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PHUONG ANH HUYNH HOANG

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 5TH AVE STE 110
SAN DIEGO CA
92103-3122
US

IV. Provider business mailing address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax: 858-795-1195
Mailing address:
  • Phone: 858-554-1212
  • Fax: 858-795-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT152745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: