Healthcare Provider Details

I. General information

NPI: 1366117426
Provider Name (Legal Business Name): KAREN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE STE 102
SAN DIEGO CA
92117-4986
US

IV. Provider business mailing address

3401 AEROJET AVE
EL MONTE CA
91731
US

V. Phone/Fax

Practice location:
  • Phone: 858-598-6789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: