Provider Demographics
NPI:1083169346
Name:HUANG, JOHN LEE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:HUANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 ADAMS AVE
Mailing Address - Street 2:SUITE 104-A
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3866
Mailing Address - Country:US
Mailing Address - Phone:657-600-8320
Mailing Address - Fax:657-600-8318
Practice Address - Street 1:1500 ADAMS AVE
Practice Address - Street 2:SUITE 104-A
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3866
Practice Address - Country:US
Practice Address - Phone:657-600-8320
Practice Address - Fax:657-600-8318
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist