Provider Demographics
NPI:1255128344
Name:HOANG, KIMVI CAO
Entity type:Individual
Prefix:
First Name:KIMVI
Middle Name:CAO
Last Name:HOANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KIMVI
Other - Middle Name:
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5172 DEL SOL CIR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2210
Mailing Address - Country:US
Mailing Address - Phone:562-552-2596
Mailing Address - Fax:
Practice Address - Street 1:5701 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2052
Practice Address - Country:US
Practice Address - Phone:763-361-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist