Provider Demographics
NPI:1740385137
Name:GEORGEANNA J HUANG MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GEORGEANNA J HUANG MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGEANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-496-9976
Mailing Address - Street 1:1000 NEWBURY RD STE 165
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6439
Mailing Address - Country:US
Mailing Address - Phone:805-496-9976
Mailing Address - Fax:805-496-9970
Practice Address - Street 1:1000 NEWBURY RD STE 165
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6439
Practice Address - Country:US
Practice Address - Phone:805-496-9976
Practice Address - Fax:805-496-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73715208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20061Medicare PIN