Provider Demographics
NPI:1003918863
Name:HUANG, XIAO-LI SHELLY (DDS)
Entity Type:Individual
Prefix:
First Name:XIAO-LI
Middle Name:SHELLY
Last Name:HUANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1136 UNION MALL
Mailing Address - Street 2:SUITE 502
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2719
Mailing Address - Country:US
Mailing Address - Phone:808-222-5390
Mailing Address - Fax:
Practice Address - Street 1:1136 UNION MALL
Practice Address - Street 2:SUITE 502
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2719
Practice Address - Country:US
Practice Address - Phone:808-947-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2118122300000X
MI2901019104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI211803OtherHDS
HI00D0Z55176OtherHMSA
HI575334Medicaid