Provider Demographics
NPI:1093732059
Name:HUANG, JIAN (MD)
Entity type:Individual
Prefix:
First Name:JIAN
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 E CLINTON AVE
Mailing Address - Street 2:PRIMARY CARE, MEDICAL SERVICE
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-2223
Mailing Address - Country:US
Mailing Address - Phone:559-225-6100
Mailing Address - Fax:559-228-5377
Practice Address - Street 1:2615 E CLINTON AVE
Practice Address - Street 2:PRIMARY CARE, MEDICAL SERVICE
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2223
Practice Address - Country:US
Practice Address - Phone:559-225-6100
Practice Address - Fax:559-228-5377
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494640Medicaid
LA5E646F600Medicare ID - Type Unspecified
LA1494640Medicaid