Healthcare Provider Details

I. General information

NPI: 1487119103
Provider Name (Legal Business Name): XIAOQIONG HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E LAS TUNAS DR STE 101
SAN GABRIEL CA
91776-1535
US

IV. Provider business mailing address

244 N SAN MARINO AVE
SAN GABRIEL CA
91775-2910
US

V. Phone/Fax

Practice location:
  • Phone: 626-286-6168
  • Fax:
Mailing address:
  • Phone: 310-600-4718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95011069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: