Healthcare Provider Details

I. General information

NPI: 1811615727
Provider Name (Legal Business Name): CHARLENE HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7195 ADVANCED WAY
LAS VEGAS NV
89113-3691
US

IV. Provider business mailing address

7195 ADVANCED WAY
LAS VEGAS NV
89113-3691
US

V. Phone/Fax

Practice location:
  • Phone: 702-740-5327
  • Fax: 702-740-5328
Mailing address:
  • Phone: 702-740-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: