Healthcare Provider Details

I. General information

NPI: 1689807471
Provider Name (Legal Business Name): TONG-YEN HUANG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA HUANG

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 DOLLEY MADISON BLVD SUITE 307
MC LEAN VA
22101-3953
US

IV. Provider business mailing address

1313 DOLLEY MADISON BLVD SUITE 307
MC LEAN VA
22101-3953
US

V. Phone/Fax

Practice location:
  • Phone: 703-847-0989
  • Fax: 703-847-2681
Mailing address:
  • Phone: 703-847-0989
  • Fax: 703-847-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401412573
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: