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General NPI Number Information
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NPI Number | 1730630021
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Entity Type | Individual
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Provider Name | MIMI HUANG
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Gender | Female
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 3600 BROADWAY
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City | OAKLAND
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State | CA
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Zip | 94611-5730
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Country | US
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Telephone | 510-752-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 785 OAK GROVE RD STE E2 #1180
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City | CONCORD
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State | CA
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Zip | 94518-3617
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Country | US
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Telephone | 925-289-8671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86077172
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License Number State | CA
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