Healthcare Provider Details

I. General information

NPI: 1568525269
Provider Name (Legal Business Name): YONGHONG HUAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET 210 WHITE BUILDING
PHILADELPHIA PA
19104-4228
US

IV. Provider business mailing address

3400 SPRUCE STREET 210 WHITE BUILDING
PHILADELPHIA PA
19104-4228
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-5703
  • Fax: 215-503-4099
Mailing address:
  • Phone: 215-349-5703
  • Fax: 215-955-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD429188
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: