Basic Information
| Provider Information | |||||||||
| NPI: | 1174140701 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JI HUANG LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 S WOODS MILL RD STE 370S | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630173603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148782460 | ||||||||
| FaxNumber: | 3148782467 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 S WOODS MILL RD STE 370S | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630173603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148782460 | ||||||||
| FaxNumber: | 3148782467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2020 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUANG | ||||||||
| AuthorizedOfficialFirstName: | JI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3148782460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.