Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 52061 | CA |
Y | 1223D0004X | Dentist Anesthesiologist | 52061 | CA |
NPI | 1659591055 |
---|---|
Provider Name | Dr. Brian C Huang |
First Address | Manhattan Beach, CA 90266-5111 |
Second Address | Manhattan Beach, CA 90266-5111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 05/09/2013 |