Healthcare Provider Details

I. General information

NPI: 1578509774
Provider Name (Legal Business Name): HUA HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136-30 MAPLE AVE 2B
FLUSHING NY
11355
US

IV. Provider business mailing address

13630 MAPLE AVE 2A
FLUSHING NY
11355-3865
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-8882
  • Fax: 718-353-8892
Mailing address:
  • Phone: 718-353-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number224006
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number224006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: