Healthcare Provider Details

I. General information

NPI: 1164090163
Provider Name (Legal Business Name): YONGXU HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

1400 BAYOU SHORE DR APT 213
GALVESTON TX
77551-4394
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-1255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberBP10074455
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: