Provider Demographics
NPI:1396062279
Name:HU, GLORIA C (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:C
Last Name:HU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2302
Mailing Address - Country:US
Mailing Address - Phone:949-923-3277
Mailing Address - Fax:855-812-5865
Practice Address - Street 1:3460 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2334
Practice Address - Country:US
Practice Address - Phone:562-594-6599
Practice Address - Fax:562-598-6220
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01391238OtherRR MEDICARE
CAP01391238OtherRR MEDICARE