Provider Demographics
NPI:1316971765
Name:HUANG, GALEN CHUNG-LIANG (MD)
Entity type:Individual
Prefix:DR
First Name:GALEN
Middle Name:CHUNG-LIANG
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHUNG LIANG
Other - Middle Name:
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6958 BROCKTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3802
Mailing Address - Country:US
Mailing Address - Phone:951-788-1450
Mailing Address - Fax:951-788-2385
Practice Address - Street 1:6958 BROCKTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3802
Practice Address - Country:US
Practice Address - Phone:951-788-1450
Practice Address - Fax:951-788-2385
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32354207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G323540Medicaid
CA00G323540Medicare ID - Type Unspecified
CAA45115Medicare UPIN