Provider Demographics
NPI:1134346257
Name:HOANG, ANH D
Entity type:Individual
Prefix:DR
First Name:ANH
Middle Name:D
Last Name:HOANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2011
Mailing Address - Country:US
Mailing Address - Phone:323-773-9961
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:4487 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-2943
Practice Address - Country:US
Practice Address - Phone:323-773-9961
Practice Address - Fax:323-773-6235
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55573Medicaid