Healthcare Provider Details

I. General information

NPI: 1407175342
Provider Name (Legal Business Name): KATHIE KAI HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26600 CACTUS AVE STE 300
MORENO VALLEY CA
92555-3901
US

IV. Provider business mailing address

26600 CACTUS AVE STE 300
MORENO VALLEY CA
92555-3901
US

V. Phone/Fax

Practice location:
  • Phone: 951-988-9500
  • Fax: 951-571-8938
Mailing address:
  • Phone: 951-988-9500
  • Fax: 951-571-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT197472
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT197472
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA125114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: