Healthcare Provider Details

I. General information

NPI: 1386405975
Provider Name (Legal Business Name): JUSTIN HUA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 BROCKTON AVE STE 214
RIVERSIDE CA
92506-2223
US

IV. Provider business mailing address

6216 BROCKTON AVE STE 214
RIVERSIDE CA
92506-2223
US

V. Phone/Fax

Practice location:
  • Phone: 951-376-3352
  • Fax: 951-376-3918
Mailing address:
  • Phone: 951-376-3352
  • Fax: 951-376-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: