Provider Demographics
NPI:1891783437
Name:HUANG, RAYMOND I (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:I
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4006
Mailing Address - Country:US
Mailing Address - Phone:408-356-8784
Mailing Address - Fax:408-358-5357
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:SUITE 309
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:408-356-8784
Practice Address - Fax:408-358-5357
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA70992207RC0000X
CAA 70992207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A709922OtherMEDICARE
CAI33152Medicare UPIN