Healthcare Provider Details

I. General information

NPI: 1184200057
Provider Name (Legal Business Name): JENNIFER HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

2621 FREEPORT BLVD
SACRAMENTO CA
95818-2442
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6602
  • Fax:
Mailing address:
  • Phone: 216-410-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number182107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: