Healthcare Provider Details

I. General information

NPI: 1124804240
Provider Name (Legal Business Name): KANGYU HUANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E SILVERADO RANCH BLVD STE 100
LAS VEGAS NV
89183-3480
US

IV. Provider business mailing address

45 E SILVERADO RANCH BLVD STE 100
LAS VEGAS NV
89183-3480
US

V. Phone/Fax

Practice location:
  • Phone: 702-425-6810
  • Fax:
Mailing address:
  • Phone: 702-425-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7897
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: