Basic Information
| Provider Information | |||||||||
| NPI: | 1831760628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUO | ||||||||
| FirstName: | KEE | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, PHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093853000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 260 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093853000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2021 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 81595 | CA | N | Nursing Service Providers | Registered Nurse | Community Health | 163W00000X | 805818 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.