Healthcare Provider Details

I. General information

NPI: 1659160646
Provider Name (Legal Business Name): JIANI HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 S KENMORE AVE APT 714
LOS ANGELES CA
90020-2758
US

IV. Provider business mailing address

453 S KENMORE AVE APT 714
LOS ANGELES CA
90020-2758
US

V. Phone/Fax

Practice location:
  • Phone: 949-394-7079
  • Fax:
Mailing address:
  • Phone: 949-394-7079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT151299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: