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General NPI Number Information
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NPI Number | 1902980147
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Entity Type | Individual
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Provider Name | JEAN HOANG OD
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 3951 GRAND AVE
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City | CHINO
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State | CA
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Zip | 91710-5429
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Country | US
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Telephone | 909-627-1507
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Fax | 909-628-6515
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Provider Business Mailing Address
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Address Line | 30 TALISMAN
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City | IRVINE
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State | CA
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Zip | 92620-3843
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Country | US
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Telephone | 909-627-1507
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Fax | 909-628-6515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12816T
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License Number State | CA
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