MEDICARE: AUDREY H HUANG MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	A94259	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A94259	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1578909008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDREY H HUANG MD INC

Provider Business Mailing Address
First Line	:	8373 SAGE DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-6931
Country	:	US
Telephone Number	:	818-957-2192
Fax Number	:	818-957-2194

Provider Business Practice Location Address
First Line	:	2155 VERDUGO BLVD # 233
Second Line	:
City	:	MONTROSE
State	:	CA
Zip	:	91020-1628
Country	:	US
Telephone Number	:	818-957-2192
Fax Number	:	818-957-2194

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	AUDREY H HUANG
Credential	:	MD
Telephone Number	:	818-957-2192

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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