Provider Demographics
NPI:1295762813
Name:HUANG, SAMUEL (OD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S NOGALES ST.
Mailing Address - Street 2:#109
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748
Mailing Address - Country:US
Mailing Address - Phone:626-965-8698
Mailing Address - Fax:626-965-8697
Practice Address - Street 1:1015 S NOGALES ST.
Practice Address - Street 2:#109
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748
Practice Address - Country:US
Practice Address - Phone:626-965-8698
Practice Address - Fax:626-965-8697
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0090130Medicaid
CAT79345Medicare UPIN
CAWOP9013DMedicare PIN