MEDICARE: JONATHAN HUANG DMD MS PHD AND MICHIKO 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	1223G0001X	General Practice Dentistry
2	1223P0700X	Prosthodontics

General Provider Information

NPI Number	:	1588183289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN HUANG DMD MS PHD AND MICHIKO HUANG DDS

Provider Business Mailing Address
First Line	:	21727 76TH AVE W STE 110
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7549
Country	:	US
Telephone Number	:	425-775-1055
Fax Number	:

Provider Business Practice Location Address
First Line	:	21727 76TH AVE W STE 110
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7549
Country	:	US
Telephone Number	:	425-775-1055
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	JONATHAN HUANG
Credential	:	DMD
Telephone Number	:	205-533-4100

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	03/18/2019

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