Provider Demographics
NPI: | 1508061300 |
---|---|
Name: | HUANG, EDMUND (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | EDMUND |
Middle Name: | |
Last Name: | HUANG |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2000 BELMONT LN |
Mailing Address - Street 2: | |
Mailing Address - City: | REDONDO BEACH |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90278-4908 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | CEDARS-SINAI COMPREHENSIVE TRANSPLANT CENTER |
Practice Address - Street 2: | 8900 BEVERLY BOULEVARD, 2ND FLOOR |
Practice Address - City: | WEST HOLLYWOOD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90048 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-248-6528 |
Practice Address - Fax: | 310-423-4678 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-06-20 |
Last Update Date: | 2019-10-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A81770 | 207R00000X, 207RN0300X |
MD | D06601 | 207R00000X, 207RN0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | KR64 | Medicare ID - Type Unspecified |