Healthcare Provider Details

I. General information

NPI: 1104473727
Provider Name (Legal Business Name): MR. DEZONG HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7273 14TH AVE STE 120B
SACRAMENTO CA
95820-3500
US

IV. Provider business mailing address

130 SUMMER STROLL CIR
SACRAMENTO CA
95823-6749
US

V. Phone/Fax

Practice location:
  • Phone: 916-245-4133
  • Fax:
Mailing address:
  • Phone: 916-420-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: