Healthcare Provider Details

I. General information

NPI: 1306474671
Provider Name (Legal Business Name): SALLY HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TAMAL PLZ STE 200
CORTE MADERA CA
94925-1063
US

IV. Provider business mailing address

100 TAMAL PLZ STE 200
CORTE MADERA CA
94925-1063
US

V. Phone/Fax

Practice location:
  • Phone: 987-041-5945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number183296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: