Healthcare Provider Details

I. General information

NPI: 1144619479
Provider Name (Legal Business Name): LISHUANG HUANG AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 FRUITDALE AVE APT D20
SAN JOSE CA
95128
US

IV. Provider business mailing address

1919 FRUITDALE AVE D20
SAN JOSE CA
95128
US

V. Phone/Fax

Practice location:
  • Phone: 702-427-5920
  • Fax:
Mailing address:
  • Phone: 702-427-5920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: