Healthcare Provider Details

I. General information

NPI: 1740385137
Provider Name (Legal Business Name): GEORGEANNA J HUANG MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 05/08/2022
Certification Date: 05/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEWBURY RD STE 165
THOUSAND OAKS CA
91320-6439
US

IV. Provider business mailing address

1000 NEWBURY RD STE 165
THOUSAND OAKS CA
91320-6439
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-9976
  • Fax: 805-496-9970
Mailing address:
  • Phone: 805-496-9976
  • Fax: 805-496-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA73715
License Number StateCA

VIII. Authorized Official

Name: GEORGEANNA J HUANG
Title or Position: PRESIDENT
Credential: MD
Phone: 805-496-9976