Healthcare Provider Details

I. General information

NPI: 1306158506
Provider Name (Legal Business Name): KEUN-HENG HUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEPHEN HUO M.D.

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18035 BROOKHURST ST STE 1200
FOUNTAIN VALLEY CA
92708-6738
US

IV. Provider business mailing address

17870 NEWHOPE ST STE 104-321
FOUNTAIN VALLEY CA
92708-5439
US

V. Phone/Fax

Practice location:
  • Phone: 949-691-3131
  • Fax: 949-940-8311
Mailing address:
  • Phone: 949-586-3200
  • Fax: 949-900-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA117599
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number117599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: