Healthcare Provider Details

I. General information

NPI: 1558135004
Provider Name (Legal Business Name): CHUNPING HUANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 S TAN CT
CHICAGO IL
60616-1998
US

IV. Provider business mailing address

1239 W NORTH SHORE AVE APT 1E
CHICAGO IL
60626-4731
US

V. Phone/Fax

Practice location:
  • Phone: 312-791-0418
  • Fax: 312-815-7302
Mailing address:
  • Phone: 312-978-7332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.028526
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: