Provider Demographics
NPI:1306529854
Name:HUANG, JUSTIN TAM (DC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:TAM
Last Name:HUANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 HELEN DR
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1652
Mailing Address - Country:US
Mailing Address - Phone:650-291-9233
Mailing Address - Fax:
Practice Address - Street 1:390 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2054
Practice Address - Country:US
Practice Address - Phone:650-670-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor