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NPI Code Detail

MEDICARE: MIMI NGOC HOANG DO

MEDICARE: MIMI NGOC HOANG DO
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
1207Q00000XFamily Medicine Physician20A22761CA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1891377594
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIMI NGOC HOANG DO
Provider Business Mailing Address
First Line : 1645 RIVENDEL DR
Second Line :
City : CORONA
State : CA
Zip : 92883-0717
Country : US
Telephone Number : 951-454-3525
Fax Number :
Provider Business Practice Location Address
First Line : 15000 KENSINGTON PARK DR
Second Line :
City : TUSTIN
State : CA
Zip : 92782-1830
Country : US
Telephone Number : 714-477-8310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2021
Last Update Date : 08/19/2025

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Directions to “ MIMI NGOC HOANG DO” Practice Location

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