Healthcare Provider Details

I. General information

NPI: 1891581369
Provider Name (Legal Business Name): WESLEY HUANG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 09/02/2025
Certification Date: 04/19/2025
Deactivation Date: 06/09/2025
Reactivation Date: 09/02/2025

III. Provider practice location address

60 HAVEN AVE
NEW YORK NY
10032-2604
US

IV. Provider business mailing address

60 HAVEN AVE
NEW YORK NY
10032-2604
US

V. Phone/Fax

Practice location:
  • Phone: 626-710-6597
  • Fax:
Mailing address:
  • Phone: 626-710-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: