Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A31495 | CA |
NPI | 1093840688 |
---|---|
Provider Name | Dr. Grady B Huckaby JR. |
First Address | Irvine, CA 92604-7706 |
Second Address | Irvine, CA 92604-7706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 30/11/2010 |