Healthcare Provider Details

I. General information

NPI: 1144901745
Provider Name (Legal Business Name): JENNY HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 W 95TH ST
OVERLAND PARK KS
66214-1831
US

IV. Provider business mailing address

8611 DRURY AVE APT 1113
KANSAS CITY MO
64132-2703
US

V. Phone/Fax

Practice location:
  • Phone: 913-802-2688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62263
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2023027070
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: