Provider Demographics
NPI:1609993682
Name:HOANG, NGOC-YEN THI (OD)
Entity Type:Individual
Prefix:
First Name:NGOC-YEN
Middle Name:THI
Last Name:HOANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E WILKEN WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-4946
Mailing Address - Country:US
Mailing Address - Phone:714-501-1009
Mailing Address - Fax:
Practice Address - Street 1:3705 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4521
Practice Address - Country:US
Practice Address - Phone:562-790-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0011650Medicaid
CA9840834OtherMEDICAL PIN
CASD0011650Medicaid
CASD0011650Medicaid