Provider Demographics
NPI:1013937747
Name:HUANG, SUMIN MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:SUMIN
Middle Name:MARK
Last Name:HUANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1909 N WATERMAN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4842
Mailing Address - Country:US
Mailing Address - Phone:909-882-8883
Mailing Address - Fax:909-882-8810
Practice Address - Street 1:1909 N WATERMAN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4842
Practice Address - Country:US
Practice Address - Phone:909-882-8883
Practice Address - Fax:909-882-8810
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7227T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0072270Medicaid
CASD0072270Medicaid