Healthcare Provider Details

I. General information

NPI: 1285404285
Provider Name (Legal Business Name): DEIRDRE HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 DOUBLETREE AVE
COLUMBUS OH
43229-1113
US

IV. Provider business mailing address

3742 CANON RIDGE PL
COLUMBUS OH
43230-4083
US

V. Phone/Fax

Practice location:
  • Phone: 614-825-6255
  • Fax:
Mailing address:
  • Phone: 614-477-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000440
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: