Provider Demographics
NPI:1790359263
Name:HUANG, SELENA (OD)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 15TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3801
Mailing Address - Country:US
Mailing Address - Phone:646-204-8662
Mailing Address - Fax:
Practice Address - Street 1:11830 NE 128TH ST STE 1
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7202
Practice Address - Country:US
Practice Address - Phone:425-821-8900
Practice Address - Fax:425-814-9782
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program