Basic Information
| Provider Information | |||||||||
| NPI: | 1295162766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUANG | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | YIMEI | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7777 FOREST LN STE C135 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752306825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723474783 | ||||||||
| FaxNumber: | 9723474916 | ||||||||
| Practice Location | |||||||||
| Address1: | 4510 MEDICAL CENTER DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750691603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723474783 | ||||||||
| FaxNumber: | 9723474916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2013 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA08742 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.