Healthcare Provider Details

I. General information

NPI: 1356989636
Provider Name (Legal Business Name): TU ANH HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PARKCENTER DR STE 235
SANTA ANA CA
92705-3588
US

IV. Provider business mailing address

3633 E BROADWAY
LONG BEACH CA
90803-6035
US

V. Phone/Fax

Practice location:
  • Phone: 714-948-7970
  • Fax:
Mailing address:
  • Phone: 424-599-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: