Healthcare Provider Details

I. General information

NPI: 1306860432
Provider Name (Legal Business Name): JOHN HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MASONIC AVE SUITE 3100
WALLINGFORD CT
06492-3095
US

IV. Provider business mailing address

67 MASONIC AVE SUITE 3100
WALLINGFORD CT
06492-3095
US

V. Phone/Fax

Practice location:
  • Phone: 203-284-3144
  • Fax: 203-284-3150
Mailing address:
  • Phone: 203-626-6511
  • Fax: 203-284-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number040314
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: