Healthcare Provider Details

I. General information

NPI: 1700450202
Provider Name (Legal Business Name): XIAORONG HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 S GARFIELD AVE STE 103
ALHAMBRA CA
91801-5068
US

IV. Provider business mailing address

25 PALATINE APT 359
IRVINE CA
92612-7658
US

V. Phone/Fax

Practice location:
  • Phone: 626-576-7871
  • Fax:
Mailing address:
  • Phone: 626-290-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: