Healthcare Provider Details

I. General information

NPI: 1013660307
Provider Name (Legal Business Name): KE HUANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY HUANG RN

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 BROADWAY STE 600
OAKLAND CA
94612-1898
US

IV. Provider business mailing address

1221 BROADWAY STE 600
OAKLAND CA
94612-1898
US

V. Phone/Fax

Practice location:
  • Phone: 415-972-4592
  • Fax:
Mailing address:
  • Phone: 415-972-4592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95085441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: