Provider Demographics
NPI:1447459151
Name:HUAN, MENGJING (MD)
Entity type:Individual
Prefix:MS
First Name:MENGJING
Middle Name:
Last Name:HUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHLOE
Other - Middle Name:
Other - Last Name:HUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5171 COTTONWOOD ST
Mailing Address - Street 2:STE 810
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5704
Mailing Address - Country:US
Mailing Address - Phone:801-507-9800
Mailing Address - Fax:801-507-9801
Practice Address - Street 1:5171 COTTONWOOD ST
Practice Address - Street 2:STE 810
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-9800
Practice Address - Fax:801-507-9801
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6283147-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTFH0209557OtherDEA