Healthcare Provider Details

I. General information

NPI: 1689332579
Provider Name (Legal Business Name): KATHRYN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 BEDFORD ST
FREMONT CA
94539-4703
US

IV. Provider business mailing address

927 BEDFORD ST
FREMONT CA
94539-4703
US

V. Phone/Fax

Practice location:
  • Phone: 408-832-8472
  • Fax:
Mailing address:
  • Phone: 408-832-8472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number301283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: