Healthcare Provider Details

I. General information

NPI: 1659778496
Provider Name (Legal Business Name): HSIN YI GRACE HUANG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S SANTA ANITA ST STE P15
SAN GABRIEL CA
91776-1165
US

IV. Provider business mailing address

207 S SANTA ANITA ST STE P15
SAN GABRIEL CA
91776-1165
US

V. Phone/Fax

Practice location:
  • Phone: 626-390-6405
  • Fax:
Mailing address:
  • Phone: 626-390-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA104119
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA104119
License Number StateCA

VIII. Authorized Official

Name: DR. HSIN YI GRACE HUANG
Title or Position: CEO
Credential: MD
Phone: 626-390-6405