Healthcare Provider Details

I. General information

NPI: 1518341247
Provider Name (Legal Business Name): HUA FENG KUAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 SAN BRUNO AVE
SAN FRANCISCO CA
94134-1510
US

IV. Provider business mailing address

1636 NORIEGA ST
SAN FRANCISCO CA
94122-4306
US

V. Phone/Fax

Practice location:
  • Phone: 415-706-7005
  • Fax:
Mailing address:
  • Phone: 628-628-1636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number64676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: