Healthcare Provider Details

I. General information

NPI: 1457767147
Provider Name (Legal Business Name): ANNIE HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

20 YELLOWSTONE DR
NEW ORLEANS LA
70131-8618
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-7801
  • Fax: 323-361-1090
Mailing address:
  • Phone: 504-491-4684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number63187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: