MEDICARE: DR. JIMMY C. HUANG D.O.

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	207Q00000X	Family Medicine Physician	20A6713	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780649442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMY C. HUANG D.O.

Provider Business Mailing Address
First Line	:	1158 26TH STREET
Second Line	:	SUITE 570
City	:	SANTA MONICA
State	:	CA
Zip	:	90403
Country	:	US
Telephone Number	:	310-453-3668
Fax Number	:	310-453-3634

Provider Business Practice Location Address
First Line	:	3756 SANTA ROSALIA DR
Second Line	:	SUITE 422
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3606
Country	:	US
Telephone Number	:	323-292-0211
Fax Number	:	323-292-0211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	09/13/2017

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