Provider Demographics
NPI:1588385223
Name:HUANG, JIAYU
Entity type:Individual
Prefix:
First Name:JIAYU
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7650
Mailing Address - Country:US
Mailing Address - Phone:504-908-4932
Mailing Address - Fax:
Practice Address - Street 1:270 NEW STATE HWY STE 9A
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-5459
Practice Address - Country:US
Practice Address - Phone:508-822-1100
Practice Address - Fax:508-386-1143
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN1859942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program