Healthcare Provider Details

I. General information

NPI: 1164059200
Provider Name (Legal Business Name): KEVIN XUE HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/04/2020
Certification Date: 07/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S COLUMBIA ST
CHAPEL HILL NC
27514-4309
US

IV. Provider business mailing address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-962-8331
  • Fax:
Mailing address:
  • Phone: 614-632-9927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberML61061814
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: