Provider Demographics
NPI:1952397937
Name:HOANG, KHANG VICTOR (DO)
Entity type:Individual
Prefix:DR
First Name:KHANG
Middle Name:VICTOR
Last Name:HOANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KHANG
Other - Middle Name:VICTOR
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:13672 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5810
Mailing Address - Country:US
Mailing Address - Phone:310-644-5097
Mailing Address - Fax:310-644-5408
Practice Address - Street 1:13672 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5810
Practice Address - Country:US
Practice Address - Phone:310-644-5097
Practice Address - Fax:310-644-5408
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5883207Q00000X, 207R00000X, 208D00000X, 207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45D0710412OtherCLIA
CA7210925OtherPIN
CA00AX58830Medicaid
CA7210925OtherPIN
CA00AX58830Medicaid