Provider Demographics
NPI:1174682280
Name:HUANG AND WU DDS INC
Entity Type:Organization
Organization Name:HUANG AND WU DDS INC
Other - Org Name:SAN MARINO DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER,CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIH-YUAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-483-8180
Mailing Address - Street 1:1901 W 8TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4900
Mailing Address - Country:US
Mailing Address - Phone:213-483-8180
Mailing Address - Fax:
Practice Address - Street 1:1901 W 8TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4900
Practice Address - Country:US
Practice Address - Phone:213-483-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410181223G0001X
CA455411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD41018OtherRENDERING PROVIDER #
CAG92054-01OtherDENTI-CAL
CAD45541OtherRENDERING PROVIDER #