Provider Demographics
NPI:1053772889
Name:HOANG, PHUONG B (NP)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:B
Last Name:HOANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S HAMMATT PKWY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-3940
Mailing Address - Country:US
Mailing Address - Phone:714-705-5977
Mailing Address - Fax:
Practice Address - Street 1:2160 S HAMMATT PKWY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-3940
Practice Address - Country:US
Practice Address - Phone:714-705-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001426363LF0000X
CA9001426363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily