Healthcare Provider Details

I. General information

NPI: 1467349522
Provider Name (Legal Business Name): ELITE WOUND CARE MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 N MASON RD STE 203
KATY TX
77449-3779
US

IV. Provider business mailing address

10602 FOUNTAIN CT
MISSOURI CITY TX
77459-1375
US

V. Phone/Fax

Practice location:
  • Phone: 347-788-8737
  • Fax:
Mailing address:
  • Phone: 347-788-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACK HUA
Title or Position: MANAGER
Credential: MD
Phone: 347-788-8737