Healthcare Provider Details

I. General information

NPI: 1508515818
Provider Name (Legal Business Name): HEIDI JUNE STAHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI JUNE HUANG

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 BERNAL RD STE B
SAN JOSE CA
95119-1809
US

IV. Provider business mailing address

2060 FAIRMONT DR
CASTRO VALLEY CA
94578-1001
US

V. Phone/Fax

Practice location:
  • Phone: 408-638-4744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA189655
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA189655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: