MEDICARE: JEN YI HUANG

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	183500000X	Pharmacist	63253	CA

General Provider Information

NPI Number	:	1952679698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEN YI HUANG

Provider Business Mailing Address
First Line	:	1104 TRINITY LN
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-4267
Country	:	US
Telephone Number	:	415-513-8502
Fax Number	:

Provider Business Practice Location Address
First Line	:	3460 EL CAMINO REAL
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-2809
Country	:	US
Telephone Number	:	408-261-1044
Fax Number	:

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

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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