Healthcare Provider Details

I. General information

NPI: 1578901088
Provider Name (Legal Business Name): CONNIE YINGYI HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HIGHLAND AVE STE 101
SALEM MA
01970-2100
US

IV. Provider business mailing address

55 HIGHLAND AVE STE 101
SALEM MA
01970-2100
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number279884
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: