Healthcare Provider Details

I. General information

NPI: 1669141529
Provider Name (Legal Business Name): HUNTINGTON MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST STE 210
PASADENA CA
91105-3027
US

IV. Provider business mailing address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-8300
  • Fax: 626-397-8337
Mailing address:
  • Phone: 626-397-8335
  • Fax: 626-397-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENDRA WILLIAMS
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 626-397-8384