Provider Demographics
NPI:1134302540
Name:AMY M. HUIBONHOA, M.D. ,INC
Entity Type:Organization
Organization Name:AMY M. HUIBONHOA, M.D. ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUIBONHOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-204-0971
Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2146
Mailing Address - Country:US
Mailing Address - Phone:510-204-0971
Mailing Address - Fax:510-549-0334
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2146
Practice Address - Country:US
Practice Address - Phone:510-204-0971
Practice Address - Fax:510-549-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77311305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG33233Medicare UPIN