Healthcare Provider Details

I. General information

NPI: 1083813158
Provider Name (Legal Business Name): GALEN C. L. HUANG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6958 BROCKTON AVE # 202
RIVERSIDE CA
92506-3802
US

IV. Provider business mailing address

6958 BROCKTON AVE # 202
RIVERSIDE CA
92506-3802
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-1450
  • Fax: 951-788-2385
Mailing address:
  • Phone: 951-788-1450
  • Fax: 951-788-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG323540
License Number StateCA

VIII. Authorized Official

Name: DR. GALEN C.L. HUANG
Title or Position: OWNER
Credential: M.D.
Phone: 951-788-1450