Healthcare Provider Details

I. General information

NPI: 1265012520
Provider Name (Legal Business Name): YA-GIN HANNA HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 HUNTINGTON DR STE G
SAN MARINO CA
91108-2357
US

IV. Provider business mailing address

1200 N STATE STREET CLINIC TOWER SUITE A7D
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-4231
  • Fax: 626-441-0282
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA191884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: