Provider Demographics
NPI:1629089842
Name:HUANG, KEVIN (LAC, NHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:LAC, NHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 BAKER ST STE A6
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4139
Mailing Address - Country:US
Mailing Address - Phone:714-979-9791
Mailing Address - Fax:
Practice Address - Street 1:1175 BAKER ST STE A6
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4139
Practice Address - Country:US
Practice Address - Phone:714-979-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist