Healthcare Provider Details

I. General information

NPI: 1487773693
Provider Name (Legal Business Name): ENG HUAN AND TIN HLA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JOSE FIGUERES AVE SUITE 430
SAN JOSE CA
95116-1500
US

IV. Provider business mailing address

200 JOSE FIGUERES AVE SUITE 430
SAN JOSE CA
95116-1500
US

V. Phone/Fax

Practice location:
  • Phone: 408-929-6088
  • Fax: 408-929-6087
Mailing address:
  • Phone: 408-929-6088
  • Fax: 408-929-6087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA36658 (ENG HUAN)
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA36657 (TIN T HLA)
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA36657 (TIN HLA)
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA36658(ENG HUAN)
License Number StateCA

VIII. Authorized Official

Name: DR. TIN TIN HLA
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 408-929-6088