MEDICARE: MICHELLE KIM-ANH HOANG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DDD101488	CA

General Provider Information

NPI Number	:	1467809368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KIM-ANH HOANG DDS

Provider Business Mailing Address
First Line	:	802 GREEN LN
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4928
Country	:	US
Telephone Number	:	310-871-9352
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 N MOUNT VERNON AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1427
Country	:	US
Telephone Number	:	909-885-8445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	07/21/2022

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