Healthcare Provider Details

I. General information

NPI: 1548580434
Provider Name (Legal Business Name): BERNARD POWEN HUANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14716 46TH AVE
FLUSHING NY
11355-2347
US

IV. Provider business mailing address

14716 46TH AVE
FLUSHING NY
11355-2347
US

V. Phone/Fax

Practice location:
  • Phone: 718-961-9726
  • Fax: 718-961-9726
Mailing address:
  • Phone: 718-961-9726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31378
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: