Healthcare Provider Details

I. General information

NPI: 1982614954
Provider Name (Legal Business Name): DR. SHOU-YIEN S. HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHOU-YIEN S. WU M.D

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST NICU 4F
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1901 W HARRISON ST NICU 4F
CHICAGO IL
60612-3714
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-4064
  • Fax: 312-864-9943
Mailing address:
  • Phone: 312-864-4064
  • Fax: 312-864-9943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036075135
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036075135
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036075135
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: