Healthcare Provider Details

I. General information

NPI: 1417804006
Provider Name (Legal Business Name): HUANAN TAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 44TH ST S APT 301
FARGO ND
58104-8425
US

IV. Provider business mailing address

3142 44TH ST S APT 301
FARGO ND
58104-8425
US

V. Phone/Fax

Practice location:
  • Phone: 917-816-2605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: