Healthcare Provider Details

I. General information

NPI: 1164875019
Provider Name (Legal Business Name): ANNA HUANG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA WANG PHD

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 KATELLA AVE STE 206
LOS ALAMITOS CA
90720-2867
US

IV. Provider business mailing address

5242 KATELLA AVE STE 206
LOS ALAMITOS CA
90720-2867
US

V. Phone/Fax

Practice location:
  • Phone: 888-699-4873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY30781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: