Provider Demographics
NPI:1598012395
Name:HUANG, DAPHNE L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:L
Last Name:HUANG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1184
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-1184
Mailing Address - Country:US
Mailing Address - Phone:530-683-5789
Mailing Address - Fax:
Practice Address - Street 1:2020 FIFTH STREET
Practice Address - Street 2:SUITE #1184
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95617-7055
Practice Address - Country:US
Practice Address - Phone:530-683-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEFE 4141213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41411Medicaid
CA000E41410Medicaid
CA000E41410Medicaid
BH5874753OtherDEA