Provider Demographics
NPI:1235179870
Name:HUANG, XIAOGUANG (MD, PHD)
Entity Type:Individual
Prefix:
First Name:XIAOGUANG
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:GUANG
Other - Middle Name:XIAO
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:345 9TH ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6522
Mailing Address - Country:US
Mailing Address - Phone:510-663-9518
Mailing Address - Fax:510-663-9520
Practice Address - Street 1:345 9TH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6522
Practice Address - Country:US
Practice Address - Phone:510-663-9518
Practice Address - Fax:510-663-9520
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A648201Medicaid
CAG87191Medicare UPIN
CA00A648201Medicare ID - Type UnspecifiedPROVIDER NUMBER
CA2958633Medicare UPIN