Healthcare Provider Details

I. General information

NPI: 1093491219
Provider Name (Legal Business Name): JUSTIN HUANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22219 MOUNTAIN HWY E STE A3
SPANAWAY WA
98387-7557
US

IV. Provider business mailing address

22219 MOUNTAIN HWY E STE A3
SPANAWAY WA
98387-7557
US

V. Phone/Fax

Practice location:
  • Phone: 253-275-1255
  • Fax:
Mailing address:
  • Phone: 253-275-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61573916
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: