Provider Demographics
NPI:1730207168
Name:HOANG, KHANH (OD)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:
Last Name:HOANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:PHUONG
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2310 RIVERSIDE CT
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-2796
Mailing Address - Country:US
Mailing Address - Phone:831-539-6836
Mailing Address - Fax:925-978-0657
Practice Address - Street 1:4893 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8553
Practice Address - Country:US
Practice Address - Phone:925-978-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11512T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist