Healthcare Provider Details

I. General information

NPI: 1164615324
Provider Name (Legal Business Name): YUNG TA HUANG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9955 LOWER AZUSA RD SUITE 201
TEMPLE CITY CA
91780-4041
US

IV. Provider business mailing address

9955 LOWER AZUSA RD SUITE 201
TEMPLE CITY CA
91780-4041
US

V. Phone/Fax

Practice location:
  • Phone: 626-258-2999
  • Fax: 626-329-2328
Mailing address:
  • Phone: 626-258-2999
  • Fax: 626-329-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37339
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number41421
License Number StateCA

VIII. Authorized Official

Name: YUNG-TA HUANG
Title or Position: DENTIST
Credential:
Phone: 626-258-2999