Healthcare Provider Details

I. General information

NPI: 1831010594
Provider Name (Legal Business Name): HOANG DENTAL MANAGEMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27365 JEFFERSON AVE STE LM
TEMECULA CA
92590-5692
US

IV. Provider business mailing address

27365 JEFFERSON AVE STE LM
TEMECULA CA
92590-5692
US

V. Phone/Fax

Practice location:
  • Phone: 951-719-1199
  • Fax: 951-719-1128
Mailing address:
  • Phone: 951-719-1199
  • Fax: 951-719-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: AMADA BOOKATZ
Title or Position: SECRETARY
Credential: RDA
Phone: 951-836-1239