Healthcare Provider Details

I. General information

NPI: 1649908518
Provider Name (Legal Business Name): VANNA THUY JANI-HOANG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S BRISTOL ST STE 208
SANTA ANA CA
92704-6233
US

IV. Provider business mailing address

18672 SANTA YNEZ ST
FOUNTAIN VALLEY CA
92708-6254
US

V. Phone/Fax

Practice location:
  • Phone: 714-571-4941
  • Fax: 714-571-4993
Mailing address:
  • Phone: 714-588-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95092224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: