Healthcare Provider Details

I. General information

NPI: 1033635495
Provider Name (Legal Business Name): JONATHAN HUANG DDS MS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21727 76TH AVE W STE 110
EDMONDS WA
98026-7549
US

IV. Provider business mailing address

19817 SUNNYSIDE DR N APT J301
SHORELINE WA
98133-2714
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-1055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60775313
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: