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General NPI Number Information
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NPI Number | 1982008934
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Entity Type | Organization
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Legal Business Name | OPD FOOT AND ANKLE
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 855 N LARK ELLEN AVE SUITE C
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City | WEST COVINA
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State | CA
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Zip | 91791-1099
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Country | US
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Telephone | 626-869-8769
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Fax | 949-579-2069
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Provider Business Mailing Address
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Address Line | 1 LEAGUE UNIT 61200
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City | IRVINE
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State | CA
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Zip | 92602-7054
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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 | KENNY HUANG
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Credential | DPM
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Telephone | 626-869-8769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | E4929
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License Number State | CA
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