Healthcare Provider Details

I. General information

NPI: 1508004201
Provider Name (Legal Business Name): XIANCHUN HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 WINCHESTER BLVD
QUEENS VILLAGE NY
11427-2128
US

IV. Provider business mailing address

374 ELM DR
ROSLYN NY
11576-3013
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-4454
  • Fax: 718-264-5052
Mailing address:
  • Phone: 718-264-4454
  • Fax: 718-264-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number268680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: