Healthcare Provider Details

I. General information

NPI: 1437512886
Provider Name (Legal Business Name): KEVIN HUANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E SUPERIOR ST STE 1600
CHICAGO IL
60611-2654
US

IV. Provider business mailing address

345 E SUPERIOR ST STE 1600
CHICAGO IL
60611-2654
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-2870
  • Fax:
Mailing address:
  • Phone: 312-238-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1437512886
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: