Healthcare Provider Details

I. General information

NPI: 1376052530
Provider Name (Legal Business Name): HUANG DDS, DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 EL CAMINO REAL 100
MILLBRAE CA
94030-1269
US

IV. Provider business mailing address

8074 PARK VILLA CIR
CUPERTINO CA
95014-4064
US

V. Phone/Fax

Practice location:
  • Phone: 650-989-8711
  • Fax:
Mailing address:
  • Phone: 14088285567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number25907
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH HUANG
Title or Position: PRESIDENT
Credential: DDS
Phone: 408-828-5567