Healthcare Provider Details

I. General information

NPI: 1609104918
Provider Name (Legal Business Name): CHARLES HUANG D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S FIGUEROA ST STE 207
LOS ANGELES CA
90071-1795
US

IV. Provider business mailing address

404 S FIGUEROA ST STE 207
LOS ANGELES CA
90071-1795
US

V. Phone/Fax

Practice location:
  • Phone: 213-486-0006
  • Fax: 213-486-0054
Mailing address:
  • Phone: 213-486-0006
  • Fax: 213-486-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: