Healthcare Provider Details

I. General information

NPI: 1750644100
Provider Name (Legal Business Name): YAFEI HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4974 MANCHESTER AVE
SAINT LOUIS MO
63110-2010
US

IV. Provider business mailing address

4974 MANCHESTER AVE
SAINT LOUIS MO
63110-2010
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-6566
  • Fax: 314-289-6364
Mailing address:
  • Phone: 314-289-6566
  • Fax: 314-289-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2012013447
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2015027342
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: