Healthcare Provider Details

I. General information

NPI: 1922847763
Provider Name (Legal Business Name): JOHN HUANG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 07/19/2025
Certification Date: 07/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

2200 WIMBERLY LN
AUSTIN TX
78735-1496
US

V. Phone/Fax

Practice location:
  • Phone: 302-593-6102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number110988
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number40709
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDS045313
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: