Healthcare Provider Details

I. General information

NPI: 1124694708
Provider Name (Legal Business Name): KIMBERLY T HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 J ST
SACRAMENTO CA
95819-3626
US

IV. Provider business mailing address

20 YORK STREET, CB-329
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-4545
  • Fax:
Mailing address:
  • Phone: 203-688-4745
  • Fax: 203-688-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95318798
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95024775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: