Healthcare Provider Details

I. General information

NPI: 1356904999
Provider Name (Legal Business Name): YICHENG HUANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 S SAN GABRIEL BLVD
SAN GABRIEL CA
91776-3656
US

IV. Provider business mailing address

20811 E CALORA ST APT F8
COVINA CA
91724-1374
US

V. Phone/Fax

Practice location:
  • Phone: 626-569-2888
  • Fax:
Mailing address:
  • Phone: 832-603-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: