Healthcare Provider Details

I. General information

NPI: 1639354285
Provider Name (Legal Business Name): TAJI HUANG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 WEST 64TH STREET
LOS ANGELES CA
90043-3519
US

IV. Provider business mailing address

4245 W 64TH ST
LOS ANGELES CA
90043-3519
US

V. Phone/Fax

Practice location:
  • Phone: 310-781-0522
  • Fax:
Mailing address:
  • Phone: 310-781-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 22717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: