MEDICARE: DR. PETER WENYEN HUANG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	61469	CA

General Provider Information

NPI Number	:	1104137314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER WENYEN HUANG DDS

Provider Business Mailing Address
First Line	:	12967 LUNA ST
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	92880-3216
Country	:	US
Telephone Number	:	949-202-9669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1791 E HOLT BLVD UNIT 102
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-2118
Country	:	US
Telephone Number	:	909-391-8990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	02/02/2021

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