Healthcare Provider Details

I. General information

NPI: 1780151936
Provider Name (Legal Business Name): SHAUN HUANG PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W OGDEN AVE
CHICAGO IL
60623-2426
US

IV. Provider business mailing address

3658 W HIRSCH ST
CHICAGO IL
60651-2120
US

V. Phone/Fax

Practice location:
  • Phone: 872-588-3200
  • Fax:
Mailing address:
  • Phone: 602-690-9473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009883
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: