Healthcare Provider Details

I. General information

NPI: 1104183417
Provider Name (Legal Business Name): JONATHAN HWAIEN HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

IV. Provider business mailing address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

V. Phone/Fax

Practice location:
  • Phone: 630-692-5700
  • Fax:
Mailing address:
  • Phone: 630-692-5700
  • Fax: 630-692-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036146694
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: