Healthcare Provider Details

I. General information

NPI: 1114532439
Provider Name (Legal Business Name): KUAN YUNG HUANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 ELMWOOD AVE
PROVIDENCE RI
02907-1547
US

IV. Provider business mailing address

243 ELMWOOD AVE
PROVIDENCE RI
02907-1547
US

V. Phone/Fax

Practice location:
  • Phone: 401-409-4553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN03896
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: