Provider Demographics
NPI:1538244611
Name:HUANG, WENHSIUNG LUKE (MD)
Entity type:Individual
Prefix:DR
First Name:WENHSIUNG
Middle Name:LUKE
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:LUKE
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:340 W CENTRAL AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3006
Mailing Address - Country:US
Mailing Address - Phone:714-990-0375
Mailing Address - Fax:714-990-0305
Practice Address - Street 1:340 W CENTRAL AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3006
Practice Address - Country:US
Practice Address - Phone:714-990-0375
Practice Address - Fax:714-990-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29899208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25368Medicare UPIN