MEDICARE: MR. IL HOON DAVID HWANG LIC. ACU., OMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC9704	CA

General Provider Information

NPI Number	:	1639120165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IL HOON DAVID HWANG LIC. ACU., OMD

Provider Business Mailing Address
First Line	:	1121 S 4TH ST
Second Line	:	SUITE A - EL CENTRO ACUPUNCTURE
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4742
Country	:	US
Telephone Number	:	760-370-0516
Fax Number	:	760-370-0516

Provider Business Practice Location Address
First Line	:	1121 S 4TH ST
Second Line	:	SUITE A - EL CENTRO ACUPUNCTURE
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4742
Country	:	US
Telephone Number	:	760-370-0516
Fax Number	:	760-370-0516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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