Healthcare Provider Details

I. General information

NPI: 1417569682
Provider Name (Legal Business Name): ANNA OANH HOANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

10181 BROOKSIDE DR
GARDEN GROVE CA
92840-1015
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-4888
  • Fax:
Mailing address:
  • Phone: 714-280-5968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95136740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: