Healthcare Provider Details

I. General information

NPI: 1588904932
Provider Name (Legal Business Name): LIEN MY HOANG MA, OTR/L, BCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SANTA ANA BLVD
SANTA ANA CA
92701-4134
US

IV. Provider business mailing address

515 E WILSON AVE
ORANGE CA
92867-4930
US

V. Phone/Fax

Practice location:
  • Phone: 714-347-0300
  • Fax: 714-347-0301
Mailing address:
  • Phone: 714-260-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number11039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: