Healthcare Provider Details

I. General information

NPI: 1750957833
Provider Name (Legal Business Name): NICOLE HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 W 32ND ST STE 400
AUSTIN TX
78705-1915
US

IV. Provider business mailing address

1004 W 32ND ST STE 400
AUSTIN TX
78705-1915
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-5171
  • Fax: 512-454-0704
Mailing address:
  • Phone: 512-454-5171
  • Fax: 512-454-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10075291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: