Provider Demographics
NPI:1669534483
Name:HUANG, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:3375 SW TERWILLIGER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4146
Mailing Address - Country:US
Mailing Address - Phone:503-494-7674
Mailing Address - Fax:503-494-3929
Practice Address - Street 1:1450 SAN PABLO ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4668
Practice Address - Country:US
Practice Address - Phone:323-442-6335
Practice Address - Fax:323-442-7166
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81104207W00000X
ORMD152539207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006810040OtherBLUE SHIELD
CAG21298Medicare UPIN
CAWG81104BMedicare PIN
CAWG81104CMedicare UPIN
CAP00168688Medicare PIN