Healthcare Provider Details

I. General information

NPI: 1891927745
Provider Name (Legal Business Name): DR. IWEI HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: IWEI M HUANG D.M.D., M.S., P.C.

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N MICHIGAN AVE SUITE 610
CHICAGO IL
60611-2615
US

IV. Provider business mailing address

737 N MICHIGAN AVE SUITE 610
CHICAGO IL
60611-2615
US

V. Phone/Fax

Practice location:
  • Phone: 312-649-9214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019025407
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021002013
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5952-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: