Provider Demographics
NPI:1669466967
Name:HOANG, MAILOAN THI (DDS)
Entity Type:Individual
Prefix:
First Name:MAILOAN
Middle Name:THI
Last Name:HOANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3102
Mailing Address - Country:US
Mailing Address - Phone:714-839-5533
Mailing Address - Fax:714-839-2425
Practice Address - Street 1:4514 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3102
Practice Address - Country:US
Practice Address - Phone:714-839-5533
Practice Address - Fax:714-839-2425
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist