Healthcare Provider Details

I. General information

NPI: 1578022059
Provider Name (Legal Business Name): XIN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 MOORPARK AVE STE 105
SAN JOSE CA
95117-1848
US

IV. Provider business mailing address

18726 S WESTERN AVE STE 408
GARDENA CA
90248-3858
US

V. Phone/Fax

Practice location:
  • Phone: 669-444-5980
  • Fax: 855-568-2494
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: