Healthcare Provider Details

I. General information

NPI: 1699874578
Provider Name (Legal Business Name): JIAPENG HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ABRAHAM FLEXNER WAY
LOUISVILLE KY
40202-1818
US

IV. Provider business mailing address

100 E LIBERTY ST STE 800
LOUISVILLE KY
40202-1428
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-4203
  • Fax: 502-587-4155
Mailing address:
  • Phone: 502-587-4404
  • Fax: 502-587-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number38874
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: