Healthcare Provider Details

I. General information

NPI: 1245193747
Provider Name (Legal Business Name): GINA GRACE HUH PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13532 LA JARA ST
CERRITOS CA
90703-6350
US

IV. Provider business mailing address

13532 LA JARA ST
CERRITOS CA
90703-6350
US

V. Phone/Fax

Practice location:
  • Phone: 562-400-5678
  • Fax:
Mailing address:
  • Phone: 562-400-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN95437179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: