Healthcare Provider Details

I. General information

NPI: 1316974561
Provider Name (Legal Business Name): MINH QUY HOANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10362 BOLSA AVE BOLSA MEDICAL GROUP
WESTMINSTER CA
92683-6763
US

IV. Provider business mailing address

10362 BOLSA AVE BOLSA MEDICAL GROUP
WESTMINSTER CA
92683-6763
US

V. Phone/Fax

Practice location:
  • Phone: 714-531-2091
  • Fax: 714-531-1403
Mailing address:
  • Phone: 714-531-2091
  • Fax: 714-531-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberG80102
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG80102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: