Healthcare Provider Details

I. General information

NPI: 1962795443
Provider Name (Legal Business Name): SHIHYAU G HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 E CESAR E CHAVEZ AVE STE 4600
LOS ANGELES CA
90033-2577
US

IV. Provider business mailing address

ONE ROBERT WOOD JOHNSON PLACE MEB 544
NEW BRUNSWICK NJ
08901-1928
US

V. Phone/Fax

Practice location:
  • Phone: 323-307-8585
  • Fax:
Mailing address:
  • Phone: 322-357-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA10156600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: