Provider Demographics
NPI:1669415378
Name:HUANG, SHIH-JWO (MD PHD FCAP)
Entity type:Individual
Prefix:
First Name:SHIH-JWO
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD PHD FCAP
Other - Prefix:
Other - First Name:OLIVER
Other - Middle Name:
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PHD FCAP
Mailing Address - Street 1:15785 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3165
Mailing Address - Country:US
Mailing Address - Phone:949-551-5525
Mailing Address - Fax:949-551-1152
Practice Address - Street 1:15785 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 115
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3165
Practice Address - Country:US
Practice Address - Phone:949-551-5525
Practice Address - Fax:949-551-1152
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72392207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A723920Medicaid
CAA72392OtherMEDICAL LICENSE
CAH95026Medicare UPIN
CAWA72392BMedicare PIN