Healthcare Provider Details

I. General information

NPI: 1174714935
Provider Name (Legal Business Name): RONY HUANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

13420 NEWPORT AVE STE C
TUSTIN CA
92780-3745
US

IV. Provider business mailing address

13420 NEWPORT AVE STE C
TUSTIN CA
92780-3745
US

V. Phone/Fax

Practice location:
  • Phone: 714-573-9200
  • Fax: 714-573-9208
Mailing address:
  • Phone: 714-573-9200
  • Fax: 714-573-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number51938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: