Provider Demographics
NPI:1083790588
Name:HUANG, YONGQIAN (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:YONGQIAN
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-0112
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:409 CUSTER WAY SE
Practice Address - Street 2:SUITE C
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3350
Practice Address - Country:US
Practice Address - Phone:360-570-8016
Practice Address - Fax:360-570-8275
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000100111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0174705OtherSTATE LABOR & INDUSTRIES
WA5050349Medicaid
WA4102HUOtherREGENCE BLUE SHIELD