Healthcare Provider Details

I. General information

NPI: 1730634700
Provider Name (Legal Business Name): LIYUN HUANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 JANES AVE
WOODRIDGE IL
60517-2356
US

IV. Provider business mailing address

7425 JANES AVE
WOODRIDGE IL
60517-2356
US

V. Phone/Fax

Practice location:
  • Phone: 815-300-7764
  • Fax:
Mailing address:
  • Phone: 815-300-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number209014572
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: