Healthcare Provider Details

I. General information

NPI: 1568872075
Provider Name (Legal Business Name): LI HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

8268 164TH ST
JAMAICA NY
11432-1104
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-3000
  • Fax:
Mailing address:
  • Phone: 718-883-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number289413
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number289413
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2894713-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: