Healthcare Provider Details

I. General information

NPI: 1205926573
Provider Name (Legal Business Name): LIJUAN HUANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W HALF DAY RD STE 106
BUFFALO GROVE IL
60089-6591
US

IV. Provider business mailing address

150 W HALF DAY RD STE 106
BUFFALO GROVE IL
60089-6591
US

V. Phone/Fax

Practice location:
  • Phone: 847-348-3357
  • Fax: 877-329-7180
Mailing address:
  • Phone: 847-348-3357
  • Fax: 847-701-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019025921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: