Provider Demographics
NPI:1598179137
Name:HUANG, PETERSON YI-JEN (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:PETERSON
Middle Name:YI-JEN
Last Name:HUANG
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PARK AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3327
Mailing Address - Country:US
Mailing Address - Phone:703-532-7586
Mailing Address - Fax:703-533-7711
Practice Address - Street 1:313 PARK AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3327
Practice Address - Country:US
Practice Address - Phone:703-532-7586
Practice Address - Fax:703-533-7711
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014138301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics