Healthcare Provider Details

I. General information

NPI: 1124247861
Provider Name (Legal Business Name): RICHARD HAO HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12595 HESPERIA ROAD SUITE 101
VICTORVILLE CA
92395-8318
US

IV. Provider business mailing address

12595 HESPERIA RD SUITE 101
VICTORVILLE CA
92395-8318
US

V. Phone/Fax

Practice location:
  • Phone: 760-881-3377
  • Fax: 760-881-3379
Mailing address:
  • Phone: 760-881-3377
  • Fax: 760-881-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA81227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: