Provider Demographics
NPI:1972812626
Name:HUANG, HAN-CHIN C (FNP)
Entity Type:Individual
Prefix:
First Name:HAN-CHIN
Middle Name:C
Last Name:HUANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6793
Mailing Address - Country:US
Mailing Address - Phone:928-846-0290
Mailing Address - Fax:
Practice Address - Street 1:1510 E WAGON WHEEL LN
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6697
Practice Address - Country:US
Practice Address - Phone:928-788-3333
Practice Address - Fax:928-788-3555
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ560526Medicaid
AZ560526Medicaid