Provider Demographics
NPI:1710321955
Name:HOANG, KIMMY (OD)
Entity Type:Individual
Prefix:
First Name:KIMMY
Middle Name:
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 1:308 MONTICELLO WEST
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022
Mailing Address - Country:US
Mailing Address - Phone:870-723-5573
Mailing Address - Fax:
Practice Address - Street 1:3929 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116
Practice Address - Country:US
Practice Address - Phone:501-412-8519
Practice Address - Fax:501-712-1414
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist