Healthcare Provider Details

I. General information

NPI: 1154325652
Provider Name (Legal Business Name): DAVID HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WILSHIRE BLVD DEPARTMENT OF RADIATION ONCOLOGY
LOS ANGELES CA
90017-1901
US

IV. Provider business mailing address

94 OLD SHORT HILLS ROAD RADIATION ONCOLOGY
LIVINGSTON NJ
07039
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-2360
  • Fax: 310-943-2703
Mailing address:
  • Phone: 973-322-5630
  • Fax: 973-322-5648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA64100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: