Healthcare Provider Details

I. General information

NPI: 1801523683
Provider Name (Legal Business Name): SIMON HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S BALDWIN AVE
ARCADIA CA
91007-7930
US

IV. Provider business mailing address

5806 CLOVERLY AVE APT A
TEMPLE CITY CA
91780-2128
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-2170
  • Fax:
Mailing address:
  • Phone: 626-679-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: