MEDICARE: DR. JONATHAN 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	102093	CA

General Provider Information

NPI Number	:	1710497409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN HUANG DDS

Provider Business Mailing Address
First Line	:	275 WALNUT AVE
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-8248
Country	:	US
Telephone Number	:	626-821-0137
Fax Number	:

Provider Business Practice Location Address
First Line	:	9955 LOWER AZUSA RD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-4059
Country	:	US
Telephone Number	:	626-258-2999
Fax Number	:

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

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/06/2017

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