MEDICARE: DR. WILLIS HUANG M.D. PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	A98053	CA

General Provider Information

NPI Number	:	1568655462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIS HUANG M.D. PHD

Provider Business Mailing Address
First Line	:	2281 PARAGON DR
Second Line	:	ROBIN MONTGOMERY, CREDENTIALING MANAGER NCI/VRI
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1307
Country	:	US
Telephone Number	:	408-961-2649
Fax Number	:	408-244-6596

Provider Business Practice Location Address
First Line	:	2281 PARAGON DR
Second Line	:	ROBIN MONTGOMERY, CREDENTIALING MANAGER NCI/VRI
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1307
Country	:	US
Telephone Number	:	408-961-2649
Fax Number	:	408-244-6596

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	02/10/2015

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