1265482020 NPI number — DR. ENG H HUAN M.D.

Table of content: DR. ENG H HUAN M.D. (NPI 1265482020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265482020 NPI number — DR. ENG H HUAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUAN
Provider First Name:
ENG
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265482020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 JOSE FIGUERES AVE
Provider Second Line Business Mailing Address:
SUITE 430
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95116-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-929-6088
Provider Business Mailing Address Fax Number:
408-929-6087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 JOSE FIGUERES AVE
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95116-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-929-6088
Provider Business Practice Location Address Fax Number:
408-929-6087
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A36658 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: A36658 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: #73 . This is a "SANTA CLARA IPA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A366580 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05-0215 . This is a "SAN JOSE MED CEN. TAX ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 110027446 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 770375452 . This is a "CPA TAX ID NUM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A36658 . This is a "CA. PHYS. LIC." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 62-1763091 . This is a "SAN JOSE TX ID NUM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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