Healthcare Provider Details

I. General information

NPI: 1639120165
Provider Name (Legal Business Name): IL HOON DAVID HWANG LIC. ACU., OMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 S 4TH ST SUITE A - EL CENTRO ACUPUNCTURE
EL CENTRO CA
92243-4742
US

IV. Provider business mailing address

1121 S 4TH ST SUITE A - EL CENTRO ACUPUNCTURE
EL CENTRO CA
92243-4742
US

V. Phone/Fax

Practice location:
  • Phone: 760-370-0516
  • Fax: 760-370-0516
Mailing address:
  • Phone: 760-370-0516
  • Fax: 760-370-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: