Provider Demographics
NPI:1275614455
Name:HUH, BRIAN N (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:N
Last Name:HUH
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 1:520 S VIRGIL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1416
Mailing Address - Country:US
Mailing Address - Phone:213-736-0080
Mailing Address - Fax:213-736-0090
Practice Address - Street 1:520 S VIRGIL AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1425
Practice Address - Country:US
Practice Address - Phone:213-736-0080
Practice Address - Fax:213-736-0090
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54802207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A548020Medicaid
CAH38169Medicare UPIN
CA00A548020Medicaid