Provider Demographics
NPI:1508420365
Name:HOANG, JESSICA SOON
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SOON
Last Name:HOANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12431 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3321
Mailing Address - Country:US
Mailing Address - Phone:714-539-3155
Mailing Address - Fax:888-475-5771
Practice Address - Street 1:12431 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3321
Practice Address - Country:US
Practice Address - Phone:714-539-3155
Practice Address - Fax:888-475-5771
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT19694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist