Healthcare Provider Details

I. General information

NPI: 1497744189
Provider Name (Legal Business Name): KUN HUANG MD. PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EVELYN AVE. STE 107
ALBANY CA
94706-1350
US

IV. Provider business mailing address

400 EVELYN AVE. STE 107
ALBANY CA
94706-1350
US

V. Phone/Fax

Practice location:
  • Phone: 510-524-4040
  • Fax: 510-524-4140
Mailing address:
  • Phone: 510-524-4040
  • Fax: 510-524-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA66759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: