Healthcare Provider Details

I. General information

NPI: 1306388699
Provider Name (Legal Business Name): KUN-HUANG HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 WINTER HUNT RD
MC LEAN VA
22102-2434
US

IV. Provider business mailing address

1202 WINTER HUNT RD
MC LEAN VA
22102-2434
US

V. Phone/Fax

Practice location:
  • Phone: 703-821-8995
  • Fax:
Mailing address:
  • Phone: 703-821-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101023576
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: