Provider Demographics
NPI:1225325129
Name:HUANG, GINTIEN (MD)
Entity Type:Individual
Prefix:
First Name:GINTIEN
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 1:1909 N WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4842
Mailing Address - Country:US
Mailing Address - Phone:909-882-8883
Mailing Address - Fax:909-882-8810
Practice Address - Street 1:1909 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4842
Practice Address - Country:US
Practice Address - Phone:909-882-8883
Practice Address - Fax:909-882-8883
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133985207W00000X
NY262015207W00000X
FLME119895207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology