Healthcare Provider Details

I. General information

NPI: 1730451238
Provider Name (Legal Business Name): JACKSON HUANG NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 VELOCITY WAY
FOSTER CITY CA
94404-4803
US

IV. Provider business mailing address

300 PASTEUR DR
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-524-0820
  • Fax: 650-267-6148
Mailing address:
  • Phone: 650-723-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95003753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: