| Jimmy C. Huang, D.o. A Professional Corp. | |
|
2210 Santa Monica Blvd. Suite C Santa Monica CA 90404 | |
| (310) 828-1708 | |
| (310) 828-1705 |
| Full Name | Jimmy C. Huang, D.o. A Professional Corp. |
|---|---|
| Speciality | Family Medicine |
| Location | 2210 Santa Monica Blvd., Santa Monica, California |
| Authorized Official Name and Position | Jimmy C. Huang (CEO) |
| Authorized Official Contact | 3232920211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jimmy C. Huang, D.o. A Professional Corp. 1158 26th Street Suite 570 Santa Monica CA 90403 Ph: (310) 453-3668 | Jimmy C. Huang, D.o. A Professional Corp. 2210 Santa Monica Blvd. Suite C Santa Monica CA 90404 Ph: (310) 828-1708 |
| NPI Number | 1023205010 |
|---|---|
| Provider Enumeration Date | 10/03/2007 |
| Last Update Date | 09/28/2017 |
| Medicare PECOS PAC ID | 9830134170 |
|---|---|
| Medicare Enrollment ID | O20081029000328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023205010 | NPI | - | NPPES |
| 00AX67131 | Medicaid | CA | |
| OOAX67131 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A6713 (California) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Jimmy C Huang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780649442 PECOS PAC ID: 5991747859 Enrollment ID: I20050601000773 |
| Provider Name | Ling Le |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780765420 PECOS PAC ID: 8527089549 Enrollment ID: I20051216000748 |
| Provider Name | Roberto T Carpio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215337084 PECOS PAC ID: 3274857537 Enrollment ID: I20150115002102 |
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