Provider Demographics
NPI:1780016170
Name:HUANG, VIVIAN (DMD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 HILLCREST AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6304
Mailing Address - Country:US
Mailing Address - Phone:925-303-2615
Mailing Address - Fax:925-303-2631
Practice Address - Street 1:3436 HILLCREST AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6304
Practice Address - Country:US
Practice Address - Phone:925-303-2615
Practice Address - Fax:925-303-2631
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice