Healthcare Provider Details

I. General information

NPI: 1427546779
Provider Name (Legal Business Name): MARSHALL JIN HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 DUPONT AVE S STE 200
BLOOMINGTON MN
55431-3200
US

IV. Provider business mailing address

9801 DUPONT AVE S STE 425
BLOOMINGTON MN
55431-3873
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-5800
  • Fax: 952-567-6156
Mailing address:
  • Phone: 952-888-5800
  • Fax: 952-567-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11410818-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number70907
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: