Healthcare Provider Details

I. General information

NPI: 1902166408
Provider Name (Legal Business Name): LEE HWANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE STE 203
PHOENIX AZ
85027-4022
US

IV. Provider business mailing address

2910 N 3RD AVE # 200
PHOENIX AZ
85013-4434
US

V. Phone/Fax

Practice location:
  • Phone: 623-562-5050
  • Fax: 623-562-5051
Mailing address:
  • Phone: 602-406-3008
  • Fax: 602-294-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number78417
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.131044
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD473053
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: