Healthcare Provider Details

I. General information

NPI: 1932199270
Provider Name (Legal Business Name): ANNA HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 PORTLAND AVE
LOUISVILLE KY
40212-1033
US

IV. Provider business mailing address

PO BOX 950244
LOUISVILLE KY
40295-0244
US

V. Phone/Fax

Practice location:
  • Phone: 502-774-8631
  • Fax: 502-772-8189
Mailing address:
  • Phone: 502-953-4700
  • Fax: 502-772-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number26851
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: