Provider Demographics
NPI:1902980147
Name:HOANG, JEAN (OD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:HOANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:30 TALISMAN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3843
Mailing Address - Country:US
Mailing Address - Phone:909-627-1507
Mailing Address - Fax:909-628-6515
Practice Address - Street 1:3951 GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5429
Practice Address - Country:US
Practice Address - Phone:909-627-1507
Practice Address - Fax:909-628-6515
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12816T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB229079Medicare PIN
CABT301AMedicare PIN