Healthcare Provider Details

I. General information

NPI: 1740749852
Provider Name (Legal Business Name): JONATHAN HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE
NEWPORT BEACH CA
92663-3637
US

IV. Provider business mailing address

520 SUPERIOR AVE
NEWPORT BEACH CA
92663-3637
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-8065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA177524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: