Provider Demographics
NPI:1013960756
Name:HUANG, GARY Y (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:Y
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67555 E PALM CANYON DR STE C112
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5412
Mailing Address - Country:US
Mailing Address - Phone:760-773-1680
Mailing Address - Fax:760-328-9379
Practice Address - Street 1:67555 E PALM CANYON DR STE C112
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5412
Practice Address - Country:US
Practice Address - Phone:760-773-1680
Practice Address - Fax:760-328-9379
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65342207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH85701Medicare UPIN