Healthcare Provider Details

I. General information

NPI: 1306007299
Provider Name (Legal Business Name): JOHN CALEB HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BLDG. 5, #6M
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

PO BOX 743749
LOS ANGELES CA
90074-3749
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA112328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: