Healthcare Provider Details

I. General information

NPI: 1912675109
Provider Name (Legal Business Name): JASON HUANG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2794 EL CAMINO REAL
SANTA CLARA CA
95051-3061
US

IV. Provider business mailing address

20621 MCCLELLAN RD
CUPERTINO CA
95014-2956
US

V. Phone/Fax

Practice location:
  • Phone: 408-248-2020
  • Fax:
Mailing address:
  • Phone: 408-242-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: