Healthcare Provider Details

I. General information

NPI: 1871290502
Provider Name (Legal Business Name): LYNN HOANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 TOWN CENTER PKWY
SANTEE CA
92071-5803
US

IV. Provider business mailing address

7300 ORIEN AVE
LA MESA CA
91941-7704
US

V. Phone/Fax

Practice location:
  • Phone: 619-448-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number107836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: