Provider Demographics
NPI:1124017595
Name:HUANG, DONALD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOHN
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:3262 N WINDSONG DR BLDG 2
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2255
Practice Address - Country:US
Practice Address - Phone:928-771-4788
Practice Address - Fax:928-771-4788
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26201208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ418295Medicaid
AZ26201OtherARIZONA MEDICAL BOARD
11030161OtherCAQH