Healthcare Provider Details

I. General information

NPI: 1134923667
Provider Name (Legal Business Name): SHIRLEY HUANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17234 VALLEY BLVD, BUILDING A
FONTANA CA
92335
US

IV. Provider business mailing address

17234 VALLEY BLVD, BUILDING A
FONTANA CA
92335
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-4128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39020000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: