Healthcare Provider Details

I. General information

NPI: 1306052204
Provider Name (Legal Business Name): DR. WEN Y HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROADWAY SUITE 206
NEW YORK NY
10013-3005
US

IV. Provider business mailing address

138 BAY RIDGE AVE
BROOKLYN NY
11220-5109
US

V. Phone/Fax

Practice location:
  • Phone: 212-226-6262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number047526
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: