=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649532003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES HUANG, DO, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2012
-----------------------------------------------------
Last Update Date | 03/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 W CENTRAL AVE SUITE 109
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-990-0375
-----------------------------------------------------
Fax | 714-990-0305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 W CENTRAL AVE SUITE 109
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-990-0375
-----------------------------------------------------
Fax | 714-990-0305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES HUANG
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 714-990-0375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------