Healthcare Provider Details

I. General information

NPI: 1629263884
Provider Name (Legal Business Name): ROBERT SHAHN-MEIR HUANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 E LAS TUNAS DR
SAN GABRIEL CA
91776-1547
US

IV. Provider business mailing address

504 E LAS TUNAS DR
SAN GABRIEL CA
91776-1547
US

V. Phone/Fax

Practice location:
  • Phone: 626-285-1918
  • Fax: 626-287-6175
Mailing address:
  • Phone: 626-285-1918
  • Fax: 626-287-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number56353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: