Provider Demographics
NPI:1801463708
Name:HUANG, YUJIE (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:YUJIE
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TULLY RD STE 602
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8982
Mailing Address - Country:US
Mailing Address - Phone:209-529-1698
Mailing Address - Fax:
Practice Address - Street 1:4101 TULLY RD STE 602
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8982
Practice Address - Country:US
Practice Address - Phone:209-529-1698
Practice Address - Fax:209-529-0058
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105679122300000X
CA1056791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty