Healthcare Provider Details

I. General information

NPI: 1962515015
Provider Name (Legal Business Name): DONALD C. HUANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N CALIFORNIA ST STE 302
STOCKTON CA
95204-6032
US

IV. Provider business mailing address

1805 N CALIFORNIA ST STE 302
STOCKTON CA
95204-6032
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-7777
  • Fax: 209-464-7789
Mailing address:
  • Phone: 209-464-7777
  • Fax: 209-464-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: