Healthcare Provider Details

I. General information

NPI: 1275218091
Provider Name (Legal Business Name): CALEB HUANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SHADOW LN
LAS VEGAS NV
89106-4119
US

IV. Provider business mailing address

620 SHADOW LN
LAS VEGAS NV
89106-4119
US

V. Phone/Fax

Practice location:
  • Phone: 702-388-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO3970
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: