Healthcare Provider Details

I. General information

NPI: 1124017595
Provider Name (Legal Business Name): DONALD JOHN HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3262 N WINDSONG DR BLDG 2
PRESCOTT VALLEY AZ
86314-2255
US

IV. Provider business mailing address

PO BOX 10880
PRESCOTT AZ
86304-0880
US

V. Phone/Fax

Practice location:
  • Phone: 928-771-4788
  • Fax: 928-771-5712
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26201
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: