Healthcare Provider Details

I. General information

NPI: 1578155644
Provider Name (Legal Business Name): YU-LUN HUANG PHD, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 04/30/2024
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 UNIVERSITY DR.
EAU CLAIRE WI
54702
US

IV. Provider business mailing address

509 UNIVERSITY DR.
EAU CLAIRE WI
54702
US

V. Phone/Fax

Practice location:
  • Phone: 715-836-3412
  • Fax:
Mailing address:
  • Phone: 715-836-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2325-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: