Healthcare Provider Details

I. General information

NPI: 1669466967
Provider Name (Legal Business Name): MAILOAN THI HOANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 W 1ST ST
SANTA ANA CA
92703-3102
US

IV. Provider business mailing address

4514 W 1ST ST
SANTA ANA CA
92703-3102
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-5533
  • Fax: 714-839-2425
Mailing address:
  • Phone: 714-839-5533
  • Fax: 714-839-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: