Provider Demographics
NPI:1609337047
Name:HUANG, BENTON (MD)
Entity Type:Individual
Prefix:
First Name:BENTON
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 1:2512 WHEATON WAY STE B
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3303
Mailing Address - Country:US
Mailing Address - Phone:360-782-5826
Mailing Address - Fax:360-782-5899
Practice Address - Street 1:2512 WHEATON WAY STE B
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3303
Practice Address - Country:US
Practice Address - Phone:360-782-5826
Practice Address - Fax:360-782-5899
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61153190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine