Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036117624 | IL |
NPI | 1295862365 |
---|---|
Provider Name | Xinyan Huang |
First Address | Springfield, IL 62703-2403 |
Second Address | Springfield, IL 62703-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 22/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036117624 | (05) | IL |