Provider Demographics
NPI:1407056880
Name:HOANG, LILY THANH (PSYD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:THANH
Last Name:HOANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-1305
Mailing Address - Country:US
Mailing Address - Phone:714-337-1446
Mailing Address - Fax:
Practice Address - Street 1:401 S TUSTIN ST
Practice Address - Street 2:BLDG. D
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2550
Practice Address - Country:US
Practice Address - Phone:714-337-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness