Provider Demographics
NPI:1366536419
Name:HUANG, KENNETH YU-YEN (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:YU-YEN
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 1:444 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2917
Mailing Address - Country:US
Mailing Address - Phone:818-552-3120
Mailing Address - Fax:
Practice Address - Street 1:444 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2917
Practice Address - Country:US
Practice Address - Phone:818-552-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73683208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A736830Medicaid
CA00A736830 851OtherCAL OPTIMA
CAWA73683AMedicare ID - Type Unspecified
CA00A736830Medicaid