Healthcare Provider Details

I. General information

NPI: 1326636127
Provider Name (Legal Business Name): KELLY HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WESTMINSTER MALL
WESTMINSTER CA
92683-4984
US

IV. Provider business mailing address

436 S BELLA VISTA ST
ANAHEIM CA
92804-2706
US

V. Phone/Fax

Practice location:
  • Phone: 714-657-1352
  • Fax:
Mailing address:
  • Phone: 714-470-3829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: