Healthcare Provider Details

I. General information

NPI: 1417253147
Provider Name (Legal Business Name): KENNY KEUI-HSIANG HUANG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N LARK ELLEN AVE SUITE C
WEST COVINA CA
91791-1099
US

IV. Provider business mailing address

1 LEAGUE UNIT 61200
IRVINE CA
92602-7054
US

V. Phone/Fax

Practice location:
  • Phone: 626-869-8769
  • Fax: 949-579-2069
Mailing address:
  • Phone: 626-869-8769
  • Fax: 949-579-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: