Healthcare Provider Details

I. General information

NPI: 1225511413
Provider Name (Legal Business Name): XURU HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14020 MAIN ST NE
DUVALL WA
98019-8457
US

IV. Provider business mailing address

1121 124TH AVE NE
BELLEVUE WA
98005-2101
US

V. Phone/Fax

Practice location:
  • Phone: 425-844-1199
  • Fax: 425-844-1850
Mailing address:
  • Phone: 425-201-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60857635
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: