Healthcare Provider Details

I. General information

NPI: 1225325129
Provider Name (Legal Business Name): GINTIEN HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 N WATERMAN AVE
SAN BERNARDINO CA
92404-4842
US

IV. Provider business mailing address

1909 N WATERMAN AVE
SAN BERNARDINO CA
92404-4842
US

V. Phone/Fax

Practice location:
  • Phone: 909-882-8883
  • Fax: 909-882-8883
Mailing address:
  • Phone: 909-882-8883
  • Fax: 909-882-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA133985
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number262015
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME119895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: