Healthcare Provider Details

I. General information

NPI: 1780635334
Provider Name (Legal Business Name): GARY Y. HUANG, MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR SUITE E-205
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

PO BOX 503
PALM SPRINGS CA
92263-0503
US

V. Phone/Fax

Practice location:
  • Phone: 760-449-0966
  • Fax: 760-864-7265
Mailing address:
  • Phone: 760-449-0966
  • Fax: 760-864-7265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA65342
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA65342
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA65342
License Number StateCA

VIII. Authorized Official

Name: GARY Y HUANG
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 760-449-0966