Healthcare Provider Details

I. General information

NPI: 1326748625
Provider Name (Legal Business Name): GI HUH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037A BEACON ST
BROOKLINE MA
02446-5609
US

IV. Provider business mailing address

471 MASSACHUSETTS AVE APT 5-2
BOSTON MA
02118-1173
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-1515
  • Fax:
Mailing address:
  • Phone: 318-780-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10000395
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: