Healthcare Provider Details

I. General information

NPI: 1679468359
Provider Name (Legal Business Name): HOANG AND NGUYEN DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S HARBOR BLVD STE D
SANTA ANA CA
92704-7901
US

IV. Provider business mailing address

15012 WINERIDGE PL
SAN DIEGO CA
92127-5002
US

V. Phone/Fax

Practice location:
  • Phone: 714-444-2744
  • Fax:
Mailing address:
  • Phone: 714-444-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDY HOANG HOANG
Title or Position: OWBER
Credential: DDS
Phone: 714-943-5364