Healthcare Provider Details

I. General information

NPI: 1194845149
Provider Name (Legal Business Name): JUNG EUN HUH D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA HUH D.M.D.

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 HIGH MOUNTAIN RD
NORTH HALEDON NJ
07508-2664
US

IV. Provider business mailing address

1111 RIVER RD B4
EDGEWATER NJ
07020-1335
US

V. Phone/Fax

Practice location:
  • Phone: 973-423-0774
  • Fax:
Mailing address:
  • Phone: 267-230-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS036876
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number052970
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02335200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: