Healthcare Provider Details

I. General information

NPI: 1770065963
Provider Name (Legal Business Name): MICHAEL TUAN HOANG DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23838 VALENCIA BLVD
VALENCIA CA
91355-5319
US

IV. Provider business mailing address

933 HILGARD AVE APT 304
LOS ANGELES CA
90024-3629
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-2960
  • Fax:
Mailing address:
  • Phone: 310-871-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS102372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: