Healthcare Provider Details

I. General information

NPI: 1679648216
Provider Name (Legal Business Name): JOHN HUANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11903 NE 128TH ST SUITE D
KIRKLAND WA
98034-7209
US

IV. Provider business mailing address

11903 NE 128TH ST SUITE D
KIRKLAND WA
98034-7209
US

V. Phone/Fax

Practice location:
  • Phone: 425-820-0900
  • Fax:
Mailing address:
  • Phone: 425-820-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00009537
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: