Provider Demographics
NPI:1639188188
Name:HOANG, JAYSON HUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:HUNG
Last Name:HOANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4402
Mailing Address - Country:US
Mailing Address - Phone:619-285-1236
Mailing Address - Fax:619-828-1009
Practice Address - Street 1:4629 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4402
Practice Address - Country:US
Practice Address - Phone:619-285-1236
Practice Address - Fax:619-285-1007
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA06-1734153OtherTAX ID
CA9023935Medicaid