Healthcare Provider Details

I. General information

NPI: 1053981589
Provider Name (Legal Business Name): SHARON HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PLAZA DR
WEST COVINA CA
91790-2803
US

IV. Provider business mailing address

496 PLAZA DR
WEST COVINA CA
91790-2854
US

V. Phone/Fax

Practice location:
  • Phone: 626-814-4681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34809TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: