Healthcare Provider Details

I. General information

NPI: 1629040878
Provider Name (Legal Business Name): CHORNG LII HWANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY HWANG MD

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81709 DR CARREON BLVD B-2
INDIO CA
92201
US

IV. Provider business mailing address

81709 DR CARREON BLVD B-2
INDIO CA
92201
US

V. Phone/Fax

Practice location:
  • Phone: 760-342-4771
  • Fax: 760-342-2289
Mailing address:
  • Phone: 760-342-4771
  • Fax: 760-342-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: