Healthcare Provider Details

I. General information

NPI: 1376463448
Provider Name (Legal Business Name): GUANGQIN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 FOUNTAINSIDE LN UNIT 303
FAIRFAX VA
22030-7413
US

IV. Provider business mailing address

4129 FOUNTAINSIDE LN UNIT 303
FAIRFAX VA
22030-7413
US

V. Phone/Fax

Practice location:
  • Phone: 804-244-3329
  • Fax:
Mailing address:
  • Phone: 804-244-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024197965
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: