Healthcare Provider Details

I. General information

NPI: 1740870237
Provider Name (Legal Business Name): FABIO HUANG YE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 HWY 95
HAWTHORNE NV
89415-7771
US

IV. Provider business mailing address

6020 KINGSMILL TER
DUBLIN CA
94568-7462
US

V. Phone/Fax

Practice location:
  • Phone: 775-945-2159
  • Fax:
Mailing address:
  • Phone: 510-493-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0018233
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20787
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: