Provider Demographics
NPI:1497744189
Name:HUANG, KUN (MD PHD)
Entity Type:Individual
Prefix:
First Name:KUN
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EVELYN AVE.
Mailing Address - Street 2:STE 107
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1350
Mailing Address - Country:US
Mailing Address - Phone:510-524-4040
Mailing Address - Fax:510-524-4140
Practice Address - Street 1:400 EVELYN AVE.
Practice Address - Street 2:STE 107
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1350
Practice Address - Country:US
Practice Address - Phone:510-524-4040
Practice Address - Fax:510-524-4140
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667590Medicaid
BH6852479OtherDEA
00A667590Medicare ID - Type Unspecified
CA00A667590Medicaid