Healthcare Provider Details

I. General information

NPI: 1902619646
Provider Name (Legal Business Name): TIFFANY OHARA HUANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

4382 JADE AVE
CYPRESS CA
90630-2050
US

V. Phone/Fax

Practice location:
  • Phone: 562-385-7442
  • Fax:
Mailing address:
  • Phone: 626-274-6462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95039280
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WU0100X
TaxonomyUrology Registered Nurse
License Number95039280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: