Healthcare Provider Details

I. General information

NPI: 1649781410
Provider Name (Legal Business Name): LIJUAN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E THOMAS RD STE 150C
PHOENIX AZ
85016-8237
US

IV. Provider business mailing address

2298 E KELLY DR
GILBERT AZ
85298-1118
US

V. Phone/Fax

Practice location:
  • Phone: 602-497-7483
  • Fax:
Mailing address:
  • Phone: 602-497-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number219417
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408304
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: