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General NPI Number Information
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NPI Number | 1568721314
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Entity Type | Organization
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Legal Business Name | BOYAO HUANG M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 2130 HUNTINGTON DR
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City | SAN MARINO
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State | CA
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Zip | 91108-2024
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Country | US
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Telephone | 626-284-9589
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Fax |
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Provider Business Mailing Address
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Address Line | 2275 HUNTINGTON DR 781
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City | SAN MARINO
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State | CA
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Zip | 91108-2640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BOYAO HUANG
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Credential | MD
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Telephone | 626-284-9589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A77036
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License Number State | CA
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