Provider Demographics
NPI:1720331556
Name:HUANG, YUAN YUAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:YUAN YUAN
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5829 182ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1522
Mailing Address - Country:US
Mailing Address - Phone:646-206-1107
Mailing Address - Fax:
Practice Address - Street 1:133-47 SANFORD AVENUE SUITE C1G
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1522
Practice Address - Country:US
Practice Address - Phone:646-206-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23 016127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant