Provider Demographics
NPI:1114677028
Name:HUO, JINGKAI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JINGKAI
Middle Name:
Last Name:HUO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12529 PRESTWICK ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-4338
Mailing Address - Country:US
Mailing Address - Phone:626-652-9086
Mailing Address - Fax:
Practice Address - Street 1:214 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3298
Practice Address - Country:US
Practice Address - Phone:626-289-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT301758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist