Provider Demographics
NPI:1609238831
Name:HUANG, TIFFANY YUAN NAOMI
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:YUAN NAOMI
Last Name:HUANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 W HUNTINGTON DR APT A
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1239
Mailing Address - Country:US
Mailing Address - Phone:626-316-3716
Mailing Address - Fax:
Practice Address - Street 1:11301 WILSHIRE BLVD # 119
Practice Address - Street 2:BUILDING 500, ROOM 6042
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:626-316-3716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA75261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program