Healthcare Provider Details

I. General information

NPI: 1871957829
Provider Name (Legal Business Name): KATHLEEN HUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE STE 200
LOS ANGELES CA
90015-3075
US

IV. Provider business mailing address

150 MUIR RD
MARTINEZ CA
94553-4668
US

V. Phone/Fax

Practice location:
  • Phone: 833-438-8763
  • Fax: 833-438-8700
Mailing address:
  • Phone: 169-843-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: