Healthcare Provider Details

I. General information

NPI: 1720580764
Provider Name (Legal Business Name): SUNGIL HWANG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 05/22/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUDLAGER 301 92249, VILSECK, GERMANY
APO AE
09112-0038
US

IV. Provider business mailing address

PSC 411 BOX 3781
APO AE
09112-0038
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3968
  • Fax:
Mailing address:
  • Phone: 314-590-3968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: