Healthcare Provider Details

I. General information

NPI: 1447322771
Provider Name (Legal Business Name): JUN TA HUANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-5806
US

IV. Provider business mailing address

1011 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-5806
US

V. Phone/Fax

Practice location:
  • Phone: 626-851-1011
  • Fax:
Mailing address:
  • Phone: 626-851-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: