Healthcare Provider Details

I. General information

NPI: 1861664849
Provider Name (Legal Business Name): KENNETH YOUNG HUH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2008
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE SUITE 308
LONG BEACH CA
90804-2105
US

IV. Provider business mailing address

1760 TERMINO AVE SUITE 308
LONG BEACH CA
90804-2105
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0249
  • Fax: 562-933-6974
Mailing address:
  • Phone: 562-933-0249
  • Fax: 562-933-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA99455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: