Provider Demographics
NPI:1578140885
Name:HUA, JEFFREY T (BSN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:HUA
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2822
Mailing Address - Country:US
Mailing Address - Phone:415-312-2826
Mailing Address - Fax:
Practice Address - Street 1:8327 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4620
Practice Address - Country:US
Practice Address - Phone:818-718-8450
Practice Address - Fax:818-718-8456
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95068965163WC0200X
CA95001551367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine