Provider Demographics
NPI:1679676787
Name:HUANG, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 CORPORATE DR
Mailing Address - Street 2:STE. 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:860 CORPORATE DR
Practice Address - Street 2:STE. 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5425
Practice Address - Country:US
Practice Address - Phone:859-223-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics