Provider Demographics
NPI:1568525269
Name:HUAN, YONGHONG (MD)
Entity Type:Individual
Prefix:
First Name:YONGHONG
Middle Name:
Last Name:HUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:210 WHITE BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4228
Mailing Address - Country:US
Mailing Address - Phone:215-349-5703
Mailing Address - Fax:215-955-2420
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:210 WHITE BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4228
Practice Address - Country:US
Practice Address - Phone:215-349-5703
Practice Address - Fax:215-503-4099
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429188207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101943185Medicaid
NJ0133965Medicaid
PA114194Medicare PIN