Provider Demographics
NPI:1295571909
Name:HOANG, DEMI KIM (OD)
Entity type:Individual
Prefix:DR
First Name:DEMI
Middle Name:KIM
Last Name:HOANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 STARBUCK ST APT D302
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5681
Mailing Address - Country:US
Mailing Address - Phone:713-839-6072
Mailing Address - Fax:
Practice Address - Street 1:1001 STARBUCK ST APT D302
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-5681
Practice Address - Country:US
Practice Address - Phone:713-839-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist