Healthcare Provider Details

I. General information

NPI: 1669567988
Provider Name (Legal Business Name): AMY HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 ZION AVE
SAN DIEGO CA
92120-2507
US

IV. Provider business mailing address

PO BOX 503892
SAN DIEGO CA
92150-3892
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-3038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: