Healthcare Provider Details

I. General information

NPI: 1558998716
Provider Name (Legal Business Name): KALYN HOFFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17601 17TH ST STE 110
TUSTIN CA
92780-1949
US

IV. Provider business mailing address

395 W 12TH AVE FL 3
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 714-790-0005
  • Fax:
Mailing address:
  • Phone: 614-293-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA194221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: