Healthcare Provider Details

I. General information

NPI: 1194969469
Provider Name (Legal Business Name): BETTY Y HUANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20445 PACIFICA DR STE C
CUPERTINO CA
95014-3017
US

IV. Provider business mailing address

20445 PACIFICA DR STE C
CUPERTINO CA
95014-3017
US

V. Phone/Fax

Practice location:
  • Phone: 408-873-9455
  • Fax:
Mailing address:
  • Phone: 408-873-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: