Healthcare Provider Details

I. General information

NPI: 1386993087
Provider Name (Legal Business Name): ANNE KIM HOANG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 GALICENO DR
LAS VEGAS NV
89122-3435
US

IV. Provider business mailing address

3945 GALICENO DR
LAS VEGAS NV
89122-3435
US

V. Phone/Fax

Practice location:
  • Phone: 949-394-0955
  • Fax:
Mailing address:
  • Phone: 949-394-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number61727
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6335
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: