Provider Demographics
NPI:1124274998
Name:HUANG, JEFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
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 1:103 N GARFIELD AVE STE E
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3578
Mailing Address - Country:US
Mailing Address - Phone:626-799-2075
Mailing Address - Fax:626-790-4554
Practice Address - Street 1:375 HUNTINGTON DR
Practice Address - Street 2:SUITE D
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2357
Practice Address - Country:US
Practice Address - Phone:626-799-2075
Practice Address - Fax:626-790-4554
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0583207W00000X
CA20A11984207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGJ790YMedicare PIN
CACB227762Medicare PIN
CACB225310Medicare PIN
CACA142002Medicare PIN
CAGJ790ZMedicare PIN