Healthcare Provider Details

I. General information

NPI: 1093883217
Provider Name (Legal Business Name): VIVIAN H.Y. HUANG L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8896 SOUTHSIDE AVE #C
ELK GROVE CA
95624-2231
US

IV. Provider business mailing address

8896 SOUTHSIDE AVE #C
ELK GROVE CA
95624-2231
US

V. Phone/Fax

Practice location:
  • Phone: 916-714-6802
  • Fax: 916-714-6803
Mailing address:
  • Phone: 916-714-6802
  • Fax: 916-714-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberAC7301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: