Healthcare Provider Details

I. General information

NPI: 1093820409
Provider Name (Legal Business Name): XIURONG LIU HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 26TH ST UNIT B
CHICAGO IL
60616-4296
US

IV. Provider business mailing address

PO BOX 167207
CHICAGO IL
60616-7207
US

V. Phone/Fax

Practice location:
  • Phone: 312-225-9012
  • Fax: 312-225-9013
Mailing address:
  • Phone: 312-225-9012
  • Fax: 312-225-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036096677
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: