1356510515 NPI number — DR. CONWAY CANHUI HUANG MD, PHD

Table of content: DR. CONWAY CANHUI HUANG MD, PHD (NPI 1356510515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356510515 NPI number — DR. CONWAY CANHUI HUANG MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUANG
Provider First Name:
CONWAY
Provider Middle Name:
CANHUI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUANG
Provider Other First Name:
CANHUI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356510515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1908 N LAURENT ST STE 410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77901-5469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-572-0333
Provider Business Mailing Address Fax Number:
361-371-7090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W CENTRAL TEXAS EXPY STE 290
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARKER HEIGHTS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76548-1991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-618-1151
Provider Business Practice Location Address Fax Number:
254-618-1158
Provider Enumeration Date:
02/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  N0842 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0782146-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 078214603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".