Provider Demographics
NPI:1033194709
Name:HUANG, CHUNG-EN (MD)
Entity Type:Individual
Prefix:
First Name:CHUNG-EN
Middle Name:
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 1:3430 W WHEATLAND RD STE 209
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3447
Mailing Address - Country:US
Mailing Address - Phone:972-780-1496
Mailing Address - Fax:972-709-1496
Practice Address - Street 1:3430 W WHEATLAND RD STE 209
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3447
Practice Address - Country:US
Practice Address - Phone:972-780-1496
Practice Address - Fax:972-709-1496
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5932207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10019261OtherAMERIGROUP
TX114357003OtherVISTA STAR HEALTH PLAN
TX114357002Medicaid
TX11736OtherPARKLAND
TX040002835OtherMEDICARE RAILROAD
TX751912167OtherBCBS
TX114357001Medicaid
TX114357001Medicaid
TX8F22464Medicare PIN
TX040002835OtherMEDICARE RAILROAD