Provider Demographics
NPI:1043437510
Name:HUANG, CLINTON (DDS)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S MISSION DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1101
Mailing Address - Country:US
Mailing Address - Phone:626-458-8428
Mailing Address - Fax:626-458-8040
Practice Address - Street 1:119 S MISSION DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1101
Practice Address - Country:US
Practice Address - Phone:626-458-8428
Practice Address - Fax:626-458-8040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB378391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice