Provider Demographics
NPI:1871503755
Name:HUANG, CHARLENE (MD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DESOTO AVENUE
Mailing Address - Street 2:SCPMG -PEDIATRICS
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365
Mailing Address - Country:US
Mailing Address - Phone:818-719-2116
Mailing Address - Fax:
Practice Address - Street 1:5601 DESOTO AVENUE
Practice Address - Street 2:SCPMG-PEDIATRICS
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91365
Practice Address - Country:US
Practice Address - Phone:818-719-4664
Practice Address - Fax:818-719-2393
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G764270OtherMEDICAL PPIN #
CAWG76427AMedicare ID - Type UnspecifiedPPIN #
CA00G764270OtherMEDICAL PPIN #