Healthcare Provider Details

I. General information

NPI: 1326580390
Provider Name (Legal Business Name): KEVIN HUANG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 FLATBUSH AVE
BROOKLYN NY
11226-5421
US

IV. Provider business mailing address

54 HIRSCH LN
STATEN ISLAND NY
10314-2731
US

V. Phone/Fax

Practice location:
  • Phone: 718-282-5330
  • Fax:
Mailing address:
  • Phone: 415-513-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number060785
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: