Healthcare Provider Details

I. General information

NPI: 1932765450
Provider Name (Legal Business Name): STEPHANIE YIHTING HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S SANTA ANITA ST STE 205
SAN GABRIEL CA
91776-1147
US

IV. Provider business mailing address

207 S SANTA ANITA ST STE 205
SAN GABRIEL CA
91776-1147
US

V. Phone/Fax

Practice location:
  • Phone: 626-576-0800
  • Fax:
Mailing address:
  • Phone: 626-576-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA180965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: