Provider Demographics
NPI:1821297151
Name:HUANG, JENHSIAN (DMD)
Entity Type:Individual
Prefix:
First Name:JENHSIAN
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 HARVARD AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2829
Mailing Address - Country:US
Mailing Address - Phone:617-783-9222
Mailing Address - Fax:
Practice Address - Street 1:196 HARVARD AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2829
Practice Address - Country:US
Practice Address - Phone:617-783-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0267015Medicaid