Provider Demographics
NPI:1891377594
Name:HOANG, MIMI NGOC (DO)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:NGOC
Last Name:HOANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 RIVENDEL DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0717
Mailing Address - Country:US
Mailing Address - Phone:951-454-3525
Mailing Address - Fax:
Practice Address - Street 1:23520 CACTUS AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8906
Practice Address - Country:US
Practice Address - Phone:951-867-3825
Practice Address - Fax:951-486-5010
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program