Individual provider Active NPI

Kevin Hoang, OD

  • Optometrist
  • San Diego, CA
National Provider Identifier
1790339216
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34401TLG Issued in CA
Practice address
4840 Shawline St
San Diego, CA 92111
Phone
(858) 717-1764
NPI assigned
Aug 1, 2019
Last updated
Jun 26, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34401TLG CA Primary

Addresses

Primary practice location

4840 Shawline St
San Diego, CA 92111

Mailing address

5093 Plaza Promenade
San Diego, CA 92123
Phone (858) 717-1764

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200205001784 CA Practitioner - Optometry 9739515057 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34401TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc. CurrentSince Jan 13, 2020 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Jan 13, 2020 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Eyesmith, a Professional Optometry Corporation Optometrist CurrentSince Mar 24, 2024 Accepting new patients
Dr Kevin Hoang OD Professional Corp Optometrist CurrentSince Sep 16, 2022 Accepting new patients

Locations

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

4029 43rd St
Ste 300
San Diego, CA 92105
Phone (619) 284-3937

4840 Shawline St
San Diego, CA 92111
Phone (858) 268-7840

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1790339216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5093 PLAZA PROMENADE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92123",
            "telephone_number": "858-717-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 SHAWLINE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92111",
            "telephone_number": "858-717-1764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOANG",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-01",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34401TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.