MEDICARE: DR. MIMI LEE HOANG PH.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	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist	PSY22006	CA

General Provider Information

NPI Number	:	1790995843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIMI LEE HOANG PH.D.

Provider Business Mailing Address
First Line	:	8821 AVIATION BLVD UNIT 88753
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90009-3769
Country	:	US
Telephone Number	:	213-207-6464
Fax Number	:

Provider Business Practice Location Address
First Line	:	7891 LA TIJERA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3145
Country	:	US
Telephone Number	:	213-207-6464
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	01/12/2024

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