Healthcare Provider Details

I. General information

NPI: 1760538193
Provider Name (Legal Business Name): HUNTINGTON MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E HUNTINGTON DR SUITE 320
ARCADIA CA
91006-3747
US

IV. Provider business mailing address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

V. Phone/Fax

Practice location:
  • Phone: 626-447-3516
  • Fax: 626-447-8546
Mailing address:
  • Phone: 626-397-8335
  • Fax: 626-397-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KENDRA WILLIAMS
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 626-397-8384