Healthcare Provider Details

I. General information

NPI: 1841382603
Provider Name (Legal Business Name): ELIZABETH THI HOANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 AVENIDA PICO STE. A
SAN CLEMENTE CA
92673-3913
US

IV. Provider business mailing address

2860 MICHELLE 2ND FLOOR
IRVINE CA
92606-1009
US

V. Phone/Fax

Practice location:
  • Phone: 949-366-9555
  • Fax: 949-355-9181
Mailing address:
  • Phone: 714-508-3600
  • Fax: 714-368-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number46393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: