Healthcare Provider Details

I. General information

NPI: 1588377667
Provider Name (Legal Business Name): XUHUA HUANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 S FAIR OAKS AVE
PASADENA CA
91105-2621
US

IV. Provider business mailing address

10565 CIVIC CENTER DR STE 250
RANCHO CUCAMONGA CA
91730-3854
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-6200
  • Fax: 626-403-2580
Mailing address:
  • Phone: 626-696-1400
  • Fax: 626-696-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: