Provider Demographics
NPI:1053877142
Name:HUANG, JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:JEAN
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 1:1524 INDEPENDENCE PKWY STE A1
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6440
Mailing Address - Country:US
Mailing Address - Phone:972-943-0410
Mailing Address - Fax:
Practice Address - Street 1:1524 INDEPENDENCE PKWY STE A1
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6440
Practice Address - Country:US
Practice Address - Phone:972-943-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA13507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program