Provider Demographics
NPI:1104902295
Name:HUANG, KENNETH (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15902A HALLIBURTON RD
Mailing Address - Street 2:#232
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3505
Mailing Address - Country:US
Mailing Address - Phone:949-542-2658
Mailing Address - Fax:
Practice Address - Street 1:15902A HALLIBURTON RD
Practice Address - Street 2:#232
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-3505
Practice Address - Country:US
Practice Address - Phone:949-542-2658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine