Healthcare Provider Details

I. General information

NPI: 1396151213
Provider Name (Legal Business Name): LUCILLE HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-1734
  • Fax: 415-353-2480
Mailing address:
  • Phone: 415-502-1734
  • Fax: 415-353-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number677264-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95002328
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95051973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: