Provider Demographics
NPI:1851019780
Name:DR KEVIN HOANG OD PROFESSIONAL CORP
Entity Type:Organization
Organization Name:DR KEVIN HOANG OD PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-717-1764
Mailing Address - Street 1:5093 PLAZA PROMENADE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-6451
Mailing Address - Country:US
Mailing Address - Phone:858-717-1764
Mailing Address - Fax:
Practice Address - Street 1:4840 SHAWLINE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1400
Practice Address - Country:US
Practice Address - Phone:858-560-5742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty