Healthcare Provider Details

I. General information

NPI: 1770996548
Provider Name (Legal Business Name): RITA HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 UNION ST SUITE 240
SAN FRANCISCO CA
94123-4114
US

IV. Provider business mailing address

21366 MISSION BLVD
HAYWARD CA
94541-2014
US

V. Phone/Fax

Practice location:
  • Phone: 415-447-6868
  • Fax: 415-447-6897
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: