Provider Demographics
NPI:1063605483
Name:HUANG, RYAN ZHONG-WEI I (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ZHONG-WEI
Last Name:HUANG
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W GRAND AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7219
Mailing Address - Country:US
Mailing Address - Phone:626-872-0836
Mailing Address - Fax:
Practice Address - Street 1:1600 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3115
Practice Address - Country:US
Practice Address - Phone:818-898-1388
Practice Address - Fax:818-270-9570
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD56071Medicaid