Provider Demographics
NPI:1780649442
Name:HUANG, JIMMY C (DO)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:C
Last Name:HUANG
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1158 26TH STREET
Mailing Address - Street 2:SUITE 570
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-453-3668
Mailing Address - Fax:310-453-3634
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:SUITE 422
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-292-0211
Practice Address - Fax:323-292-0211
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2017-09-13
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Provider Licenses
StateLicense IDTaxonomies
CA20A6713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOAX67131Medicaid
CAOOAX67131Medicaid
CAW20A6713AMedicare PIN