Healthcare Provider Details

I. General information

NPI: 1336621549
Provider Name (Legal Business Name): XUELIAN HUANG DDS, MS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 PARK AVE N STE B
RENTON WA
98057-5522
US

IV. Provider business mailing address

525 PARK AVE N STE B
RENTON WA
98057-5522
US

V. Phone/Fax

Practice location:
  • Phone: 425-793-1789
  • Fax:
Mailing address:
  • Phone: 425-793-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60796129
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: