Provider Demographics
NPI:1376574624
Name:HUANG, JIMMY CHUNG-SHWUN (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:CHUNG-SHWUN
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIMMY
Other - Middle Name:CHUNG-SHWUN
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1016 HIGHLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3479
Mailing Address - Country:US
Mailing Address - Phone:310-497-8698
Mailing Address - Fax:626-967-5577
Practice Address - Street 1:2461 SANTA MONICA BLVD
Practice Address - Street 2:#108
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2138
Practice Address - Country:US
Practice Address - Phone:866-487-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA774552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I-40831Medicare UPIN
PA122630Medicare PIN