Healthcare Provider Details

I. General information

NPI: 1689889206
Provider Name (Legal Business Name): CAROLINE YINGWEN HU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 BROADWAY FL 14
OAKLAND CA
94611-5714
US

IV. Provider business mailing address

KAISER PERMANENTE-OAKLAND 3505 BROADWAY, 14TH FLOOR
OAKLAND CA
94611
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-6592
  • Fax:
Mailing address:
  • Phone: 510-752-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08952700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number243329
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberC162620
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.135212
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: