Healthcare Provider Details

I. General information

NPI: 1679957526
Provider Name (Legal Business Name): ANDREW JONATHAN HUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N 28TH AVE
WAUSAU WI
54401-4100
US

IV. Provider business mailing address

1708 MARQUARDT RD
WAUSAU WI
54403-4311
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2866
  • Fax:
Mailing address:
  • Phone: 949-303-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA144541
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number71451-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: