Basic Information
| Provider Information | |||||||||
| NPI: | 1912013384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUANG | ||||||||
| FirstName: | YAN | ||||||||
| MiddleName: | NMN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 MILL LN | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928311046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988614 | ||||||||
| FaxNumber: | 2707988633 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG 2441 21ST STREET | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FORT CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422235369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988614 | ||||||||
| FaxNumber: | 2707988633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 01/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DDS58756 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.