=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457821209
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES HUANG DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2018
-----------------------------------------------------
Last Update Date | 12/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31571 CANYON ESTATES DR STE 200
-----------------------------------------------------
City | LAKE ELSINORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92532-0412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-471-8979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13072 BOSTON AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-5935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-552-5246
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DDS103013
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------