Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 60523 | CA |
NPI | 1003104589 |
---|---|
Provider Name | Huang Kevin Cheng |
First Address | Newark, CA 94560-5367 |
Second Address | Newark, CA 94560-5367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2011 |
Last Update Date | 29/05/2013 |