Healthcare Provider Details

I. General information

NPI: 1932634110
Provider Name (Legal Business Name): KAI HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date: 11/27/2017
Reactivation Date: 12/06/2017

III. Provider practice location address

1821 S WEBSTER AVE
GREEN BAY WI
54301-2253
US

IV. Provider business mailing address

1821 S WEBSTER AVE
GREEN BAY WI
54301-2253
US

V. Phone/Fax

Practice location:
  • Phone: 920-272-3350
  • Fax:
Mailing address:
  • Phone: 920-272-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-49575
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN25726
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number81269-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: