Healthcare Provider Details

I. General information

NPI: 1851711774
Provider Name (Legal Business Name): JONATHAN HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ MS: BCM120
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

1 BAYLOR PLZ MS: BCM120
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-5117
  • Fax: 713-798-6374
Mailing address:
  • Phone: 713-798-5117
  • Fax: 713-798-6374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBP10049544
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: