Provider Demographics
NPI:1366410714
Name:HUANG, JERRY CHIH KAI (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:CHIH KAI
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 1:6557 GREENLEAF AVE
Mailing Address - Street 2:INTERCOMMUNITY HEALTH ASSOCIATES, INC.
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4108
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-789-5473
Practice Address - Street 1:12401 WASHINGTON BLVD
Practice Address - Street 2:PIH HEALTH HOSPITAL
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1006
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-789-5473
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A697690Medicaid
CA00A697690Medicaid
H35392Medicare UPIN