Healthcare Provider Details

I. General information

NPI: 1366094856
Provider Name (Legal Business Name): GILBERT K HUANG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S SAN MATEO DR STE 212
SAN MATEO CA
94401-3843
US

IV. Provider business mailing address

550 OLIVE AVE
FREMONT CA
94539-5263
US

V. Phone/Fax

Practice location:
  • Phone: 650-342-5733
  • Fax: 650-342-0525
Mailing address:
  • Phone: 510-517-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135001064
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: