=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609437599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GINTIEN HUANG MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2019
-----------------------------------------------------
Last Update Date | 08/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1909 N WATERMAN AVE STE 3
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92404-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-882-8829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1909 N WATERMAN AVE STE 3
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92404-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-882-8829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GINTIEN HUANG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 909-882-8829
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------