Healthcare Provider Details

I. General information

NPI: 1588718175
Provider Name (Legal Business Name): LIJIANG HUANG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W VALLEY BLVD
ALHAMBRA CA
91803-1926
US

IV. Provider business mailing address

526 WORKMAN AVE
ARCADIA CA
91007-8455
US

V. Phone/Fax

Practice location:
  • Phone: 626-284-8881
  • Fax: 626-284-6805
Mailing address:
  • Phone: 626-446-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: