Healthcare Provider Details

I. General information

NPI: 1043201155
Provider Name (Legal Business Name): THOMAS C HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2552 WALNUT AVE STE 130
TUSTIN CA
92780-6970
US

IV. Provider business mailing address

10197 OVERHILL DR
SANTA ANA CA
92705
US

V. Phone/Fax

Practice location:
  • Phone: 714-508-1600
  • Fax: 714-312-1109
Mailing address:
  • Phone: 714-878-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG61652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: