Provider Demographics
NPI:1376645804
Name:HUANG, WENTZY (DO)
Entity Type:Individual
Prefix:DR
First Name:WENTZY
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 NW 131ST ST
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7448
Mailing Address - Country:US
Mailing Address - Phone:515-225-7390
Mailing Address - Fax:
Practice Address - Street 1:909 ARMY POST RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-5569
Practice Address - Country:US
Practice Address - Phone:515-287-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0210351Medicaid
IAA02042Medicare UPIN
IA0210351Medicaid