Healthcare Provider Details

I. General information

NPI: 1942073002
Provider Name (Legal Business Name): ROGER HUANG PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 SAWTELLE BLVD STE 610
LOS ANGELES CA
90025-7013
US

IV. Provider business mailing address

10736 JEFFERSON BLVD # 614
CULVER CITY CA
90230-4933
US

V. Phone/Fax

Practice location:
  • Phone: 424-210-7724
  • Fax:
Mailing address:
  • Phone: 424-210-7724
  • Fax: 800-493-9423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037394
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95296380
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN61393139
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: