Healthcare Provider Details

I. General information

NPI: 1780594713
Provider Name (Legal Business Name): KIM THUY HO HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SANTA INES ST
ROSEVILLE CA
95747-4960
US

IV. Provider business mailing address

1820 SANTA INES ST
ROSEVILLE CA
95747-4960
US

V. Phone/Fax

Practice location:
  • Phone: 916-400-1250
  • Fax:
Mailing address:
  • Phone: 916-400-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: