Provider Demographics
NPI:1407830912
Name:HUH, YOUNG B (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:B
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 1:2222 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7546
Mailing Address - Country:US
Mailing Address - Phone:563-421-8900
Mailing Address - Fax:563-421-8909
Practice Address - Street 1:2222 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7546
Practice Address - Country:US
Practice Address - Phone:563-383-2686
Practice Address - Fax:563-884-8144
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33992207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0234781Medicaid
1240088OtherCSA
BH4830508OtherDEA
IA0234781Medicaid
1240088OtherCSA
G38144Medicare UPIN