Healthcare Provider Details

I. General information

NPI: 1417035486
Provider Name (Legal Business Name): HSU-TI HUANG DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 S SUNSET AVE STE 202
WEST COVINA CA
91790-3410
US

IV. Provider business mailing address

933 S SUNSET AVE STE 202
WEST COVINA CA
91790-3410
US

V. Phone/Fax

Practice location:
  • Phone: 626-813-6630
  • Fax: 626-813-3539
Mailing address:
  • Phone: 626-813-6630
  • Fax: 626-813-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5468710001
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4535
License Number StateCA

VIII. Authorized Official

Name: HSU-TI HUANG
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 626-813-6630