Healthcare Provider Details

I. General information

NPI: 1700200433
Provider Name (Legal Business Name): HUNG HUA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 MACARTHUR BLVD
SAN LEANDRO CA
94577-3918
US

IV. Provider business mailing address

1355 MACARTHUR BLVD
SAN LEANDRO CA
94577-3918
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-3677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: