Healthcare Provider Details

I. General information

NPI: 1578792701
Provider Name (Legal Business Name): JI YOUNG HUH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 CENTRE AVE
PITTSBURGH PA
15232-1303
US

IV. Provider business mailing address

5215 CENTRE AVE
PITTSBURGH PA
15232-1303
US

V. Phone/Fax

Practice location:
  • Phone: 412-623-2817
  • Fax: 412-623-3704
Mailing address:
  • Phone: 412-623-2817
  • Fax: 412-623-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT194887
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: