Healthcare Provider Details

I. General information

NPI: 1962082982
Provider Name (Legal Business Name): TRACE HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25745 BARTON RD # 701
LOMA LINDA CA
92354-3812
US

IV. Provider business mailing address

25745 BARTON RD # 701
LOMA LINDA CA
92354-3812
US

V. Phone/Fax

Practice location:
  • Phone: 949-689-8745
  • Fax:
Mailing address:
  • Phone: 949-689-8745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA184051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: