Healthcare Provider Details

I. General information

NPI: 1124963954
Provider Name (Legal Business Name): ERIC HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 E 4TH ST
SANTA ANA CA
92701-5164
US

IV. Provider business mailing address

578 WASHINGTON BLVD STE 913
MARINA DEL REY CA
90292-5421
US

V. Phone/Fax

Practice location:
  • Phone: 424-272-5238
  • Fax:
Mailing address:
  • Phone: 424-272-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: