Provider Demographics
NPI:1639159650
Name:HUANG, AN-JEN (MD)
Entity Type:Individual
Prefix:
First Name:AN-JEN
Middle Name:
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 1:3724 CENTER RD
Mailing Address - Street 2:STE 102
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4439
Mailing Address - Country:US
Mailing Address - Phone:330-225-7733
Mailing Address - Fax:330-220-0902
Practice Address - Street 1:3724 CENTER RD
Practice Address - Street 2:STE 102
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4439
Practice Address - Country:US
Practice Address - Phone:330-225-7733
Practice Address - Fax:330-220-0902
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052528207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0603476Medicaid
A16240Medicare UPIN
OH0573954Medicare ID - Type Unspecified