Healthcare Provider Details

I. General information

NPI: 1659591055
Provider Name (Legal Business Name): BRIAN C HUANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N SEPULVEDA BLVD #251
MANHATTAN BEACH CA
90266-5111
US

IV. Provider business mailing address

1601 N SEPULVEDA BLVD #251
MANHATTAN BEACH CA
90266-5111
US

V. Phone/Fax

Practice location:
  • Phone: 213-590-8053
  • Fax:
Mailing address:
  • Phone: 213-590-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number52061
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number52061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: