Healthcare Provider Details

I. General information

NPI: 1396739686
Provider Name (Legal Business Name): JEFFREY D HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 11/27/2023
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PARK ST SE SUITE 300
VIENNA VA
22180-4653
US

IV. Provider business mailing address

115 PARK ST SE SUITE 300
VIENNA VA
22180-4653
US

V. Phone/Fax

Practice location:
  • Phone: 703-255-9100
  • Fax: 703-255-3457
Mailing address:
  • Phone: 703-255-9100
  • Fax: 703-255-3457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101226753
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: