Provider Demographics
NPI:1013263748
Name:HUANG, JACK (LAC, DILP OM)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:LAC, DILP OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ORRIS ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1312
Mailing Address - Country:US
Mailing Address - Phone:617-306-2532
Mailing Address - Fax:
Practice Address - Street 1:209 HARVARD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5071
Practice Address - Country:US
Practice Address - Phone:857-366-7658
Practice Address - Fax:617-995-0928
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253692171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist