Healthcare Provider Details

I. General information

NPI: 1578798948
Provider Name (Legal Business Name): JIN QUAN HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 GRAND CONCOURSE FL 2
BRONX NY
10453-4995
US

IV. Provider business mailing address

1963 GRAND CONCOURSE FL 2
BRONX NY
10453-4995
US

V. Phone/Fax

Practice location:
  • Phone: 718-294-5000
  • Fax: 718-294-6060
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: