Healthcare Provider Details

I. General information

NPI: 1811084619
Provider Name (Legal Business Name): ISSAC K HUANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 LOMITA BLVD #208
TORRANCE CA
90505
US

IV. Provider business mailing address

3640 LOMITA BLVD #208
TORRANCE CA
90505
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-3200
  • Fax: 310-378-7358
Mailing address:
  • Phone: 310-373-3200
  • Fax: 310-378-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: