Healthcare Provider Details

I. General information

NPI: 1225186257
Provider Name (Legal Business Name): SCOTT LI-JU HUANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 PARIS ST STE 202
SAN FRANCISCO CA
94112-3858
US

IV. Provider business mailing address

888 PARIS ST STE 202
SAN FRANCISCO CA
94112-3858
US

V. Phone/Fax

Practice location:
  • Phone: 415-677-2488
  • Fax: 415-217-4199
Mailing address:
  • Phone: 415-677-2488
  • Fax: 415-217-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: