1033139647 NPI number — CHING-CHIH DAVID HUANG M.D.INC A

Table of content: (NPI 1033139647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033139647 NPI number — CHING-CHIH DAVID HUANG M.D.INC A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHING-CHIH DAVID HUANG M.D.INC A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033139647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 E ARTESIA AVE, #235
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91767-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-397-5205
Provider Business Mailing Address Fax Number:
909-397-5207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 E ARTESIA ST STE 235
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91767-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-397-5205
Provider Business Practice Location Address Fax Number:
909-397-5208
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUANG
Authorized Official First Name:
CHING-CHIH
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
909-397-5205

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A477540 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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