Healthcare Provider Details

I. General information

NPI: 1275906950
Provider Name (Legal Business Name): JENNIE HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 PUENTE AVE
BALDWIN PARK CA
91706-5923
US

IV. Provider business mailing address

2265 SHADY OAKS RD
GLENDORA CA
91741-4605
US

V. Phone/Fax

Practice location:
  • Phone: 626-814-1483
  • Fax: 626-814-1493
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: