MEDICARE: DR. TIMOTHY J. HOANG PSY.D.

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	103TC0700X	Clinical Psychologist	PSY18203	CA

General Provider Information

NPI Number	:	1639183387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY J. HOANG PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 72
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92781-0072
Country	:	US
Telephone Number	:	714-470-2221
Fax Number	:	714-892-0090

Provider Business Practice Location Address
First Line	:	405 W 5TH ST
Second Line	:	202A
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4599
Country	:	US
Telephone Number	:	714-470-2221
Fax Number	:	714-892-0090

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	12/15/2008

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