Healthcare Provider Details

I. General information

NPI: 1245193747
Provider Name (Legal Business Name): GINA GRACE HUH PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E 111TH ST
LOS ANGELES CA
90061-3004
US

IV. Provider business mailing address

13532 LA JARA ST
CERRITOS CA
90703-6350
US

V. Phone/Fax

Practice location:
  • Phone: 562-400-5678
  • Fax:
Mailing address:
  • Phone: 323-789-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95437179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: