Healthcare Provider Details

I. General information

NPI: 1316387715
Provider Name (Legal Business Name): MARC HUI HUH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 W AVENUE Q STE C
PALMDALE CA
93551-3892
US

IV. Provider business mailing address

PO BOX 7001
TARZANA CA
91357-7001
US

V. Phone/Fax

Practice location:
  • Phone: 661-266-2994
  • Fax: 818-715-1722
Mailing address:
  • Phone: 818-888-7815
  • Fax: 818-715-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA137535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: