1376052530 NPI number — HUANG DDS, DENTAL CORP

Table of content: JOANNA DOMBAL (NPI 1912713256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376052530 NPI number — HUANG DDS, DENTAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUANG DDS, DENTAL CORP
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:
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:
1376052530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8074 PARK VILLA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUPERTINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95014-4064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
14088285567
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1641 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
MILLBRAE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94030-1269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-989-8711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HUANG
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
408-828-5567

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  25907 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1710019161 . This is a "TYPE 1 NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 25907 . This is a "CA DENTAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 25907 . This is a "DENTAL PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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