Healthcare Provider Details

I. General information

NPI: 1669193587
Provider Name (Legal Business Name): MK HOANG OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1102 IRVINE BLVD
TUSTIN CA
92780-3529
US

IV. Provider business mailing address

1102 IRVINE BLVD
TUSTIN CA
92780-3529
US

V. Phone/Fax

Practice location:
  • Phone: 714-838-3210
  • Fax: 714-838-5702
Mailing address:
  • Phone: 714-838-3210
  • Fax: 714-838-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MARY KIM HOANG
Title or Position: OPTOMETRIST
Credential: OD
Phone: 562-209-1255