Provider Demographics
NPI:1417395633
Name:HALL, BONNIE HUANG (MD PHD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:HUANG
Last Name:HALL
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46923 WARM SPRINGS BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7977
Mailing Address - Country:US
Mailing Address - Phone:510-624-9137
Mailing Address - Fax:510-624-9158
Practice Address - Street 1:46923 WARM SPRINGS BLVD STE 206
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7977
Practice Address - Country:US
Practice Address - Phone:510-624-9137
Practice Address - Fax:510-624-9158
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine