Healthcare Provider Details

I. General information

NPI: 1275078446
Provider Name (Legal Business Name): AMY HUNGYUN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 YORK RD STE 301
LUTHERVILLE TIMONIUM MD
21093-6022
US

IV. Provider business mailing address

1447 YORK RD STE 301
LUTHERVILLE TIMONIUM MD
21093-6022
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-9090
  • Fax:
Mailing address:
  • Phone: 410-252-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0099803
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: