Healthcare Provider Details

I. General information

NPI: 1205508439
Provider Name (Legal Business Name): SAMUEL HUANG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 06/02/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 STANTON L YOUNG BLVD DMEI 509
OKC OK
73104
US

IV. Provider business mailing address

608 STANTON L YOUNG BLVD DMEI 509
OKC OK
73104
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7816
  • Fax:
Mailing address:
  • Phone: 405-271-7816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number41439
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: