Healthcare Provider Details

I. General information

NPI: 1215668611
Provider Name (Legal Business Name): MR. SHAO-PO HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-9006
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-9006
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-2168
  • Fax: 214-648-7517
Mailing address:
  • Phone: 214-648-2168
  • Fax: 214-648-7517

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: