Healthcare Provider Details

I. General information

NPI: 1639159650
Provider Name (Legal Business Name): AN-JEN HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 CENTER RD STE 102
BRUNSWICK OH
44212-4439
US

IV. Provider business mailing address

3724 CENTER RD STE 102
BRUNSWICK OH
44212-4439
US

V. Phone/Fax

Practice location:
  • Phone: 330-225-7733
  • Fax: 330-220-0902
Mailing address:
  • Phone: 330-225-7733
  • Fax: 330-220-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35052528
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: