Provider Demographics
NPI:1851726715
Name:HOANG, KAITY (OD)
Entity Type:Individual
Prefix:
First Name:KAITY
Middle Name:
Last Name:HOANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAITY
Other - Middle Name:
Other - Last Name:SHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:10727 GATEWAY BLVD W
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4906
Mailing Address - Country:US
Mailing Address - Phone:915-592-4600
Mailing Address - Fax:855-827-7401
Practice Address - Street 1:10727 GATEWAY BLVD W
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4906
Practice Address - Country:US
Practice Address - Phone:915-592-4600
Practice Address - Fax:855-827-7401
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8318T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist