Healthcare Provider Details

I. General information

NPI: 1578301495
Provider Name (Legal Business Name): DAZZLE HEALTH P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14642 NEWPORT AVE STE 408
TUSTIN CA
92780-6091
US

IV. Provider business mailing address

18650 MACARTHUR BLVD STE 450
IRVINE CA
92612-1253
US

V. Phone/Fax

Practice location:
  • Phone: 949-570-7750
  • Fax: 949-570-7965
Mailing address:
  • Phone: 949-570-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN SOO HOO
Title or Position: CO-FOUNDER
Credential:
Phone: 626-807-9978