Healthcare Provider Details

I. General information

NPI: 1154957124
Provider Name (Legal Business Name): KENNETH HUI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TELEGRAPH AVE # 2000
OAKLAND CA
94609-3239
US

IV. Provider business mailing address

3100 TELEGRAPH AVE # 2000
OAKLAND CA
94609-3239
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8290
  • Fax:
Mailing address:
  • Phone: 510-204-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA179706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: