Healthcare Provider Details

I. General information

NPI: 1215323621
Provider Name (Legal Business Name): GRACE PO-AN HUANG AMADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 1600
SACRAMENTO CA
95817
US

IV. Provider business mailing address

4860 Y ST STE 1600
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3630
  • Fax: 916-734-5636
Mailing address:
  • Phone: 916-734-3630
  • Fax: 916-734-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA162520
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA162520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: