Healthcare Provider Details

I. General information

NPI: 1790954832
Provider Name (Legal Business Name): HELEN HUANG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17251 FOOTHILL BLVD
FONTANA CA
92335-9044
US

IV. Provider business mailing address

19746 LOS PINOS DR
WALNUT CA
91789-1724
US

V. Phone/Fax

Practice location:
  • Phone: 909-355-3156
  • Fax:
Mailing address:
  • Phone: 858-349-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: