Provider Demographics
NPI:1407177181
Name:HUANG, CHUN PO (DDS)
Entity Type:Individual
Prefix:
First Name:CHUN
Middle Name:PO
Last Name:HUANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 COFFEE RD
Mailing Address - Street 2:C-4
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2413
Mailing Address - Country:US
Mailing Address - Phone:209-238-9444
Mailing Address - Fax:209-238-9446
Practice Address - Street 1:2030 COFFEE RD
Practice Address - Street 2:C-4
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2413
Practice Address - Country:US
Practice Address - Phone:209-238-9444
Practice Address - Fax:209-238-9446
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice