Healthcare Provider Details

I. General information

NPI: 1639308497
Provider Name (Legal Business Name): HUH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

2202 PHELPS RD
HYATTSVILLE MD
20783-4450
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6613
  • Fax:
Mailing address:
  • Phone: 714-686-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. SIMON LEUL
Title or Position: INTERN
Credential: M.D
Phone: 714-686-3681