Healthcare Provider Details

I. General information

NPI: 1477927796
Provider Name (Legal Business Name): LI QIAO HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE STE 300
SAN JOSE CA
95128
US

IV. Provider business mailing address

99 ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-2730
  • Fax:
Mailing address:
  • Phone: 760-977-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTI IMF 89590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: