Healthcare Provider Details

I. General information

NPI: 1326224080
Provider Name (Legal Business Name): JOHNSON HUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 16TH ST SUITE A454
SANTA MONICA CA
90404-1249
US

IV. Provider business mailing address

1250 16TH ST SUITE A454
SANTA MONICA CA
90404-1249
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-4698
  • Fax: 310-319-4908
Mailing address:
  • Phone: 310-319-4698
  • Fax: 310-319-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA102163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: