Healthcare Provider Details

I. General information

NPI: 1861917973
Provider Name (Legal Business Name): TIFFANY HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 BROAD STREET
SAN FRANCISCO CA
94112
US

IV. Provider business mailing address

262 BROAD ST
SAN FRANCISCO CA
94112-2927
US

V. Phone/Fax

Practice location:
  • Phone: 415-710-5325
  • Fax:
Mailing address:
  • Phone: 415-710-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: