Provider Demographics
NPI:1477756872
Name:HUANG, ELLEN (PA-C, FNP)
Entity Type:Individual
Prefix:MISS
First Name:ELLEN
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:PA-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39001 SUNDALE DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2005
Mailing Address - Country:US
Mailing Address - Phone:510-789-9873
Mailing Address - Fax:
Practice Address - Street 1:39001 SUNDALE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2005
Practice Address - Country:US
Practice Address - Phone:510-789-9873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17875363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24638ZMedicare PIN