Healthcare Provider Details

I. General information

NPI: 1265348148
Provider Name (Legal Business Name): LIQI HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ROUTE 3
DEDEDO GU
96929-6911
US

IV. Provider business mailing address

3615 MCCLELAND CREEK TRL
TEMPLE TX
76502-6710
US

V. Phone/Fax

Practice location:
  • Phone: 671-645-5500
  • Fax:
Mailing address:
  • Phone: 245-856-7178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1031289
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: