Healthcare Provider Details

I. General information

NPI: 1316802887
Provider Name (Legal Business Name): JASON LEE HUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 DARDANELLI LN STE 10
LOS GATOS CA
95032-1418
US

IV. Provider business mailing address

PO BOX 31396
WALNUT CREEK CA
94598-8396
US

V. Phone/Fax

Practice location:
  • Phone: 408-412-8100
  • Fax:
Mailing address:
  • Phone: 925-939-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number67850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: