Provider Demographics
NPI:1861862906
Name:HOANG, MARY KIM (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KIM
Last Name:HOANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1102 IRVINE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3529
Mailing Address - Country:US
Mailing Address - Phone:714-838-3210
Mailing Address - Fax:714-838-5702
Practice Address - Street 1:1102 IRVINE BLVD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3529
Practice Address - Country:US
Practice Address - Phone:714-838-3210
Practice Address - Fax:714-838-5702
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist