Healthcare Provider Details

I. General information

NPI: 1629235510
Provider Name (Legal Business Name): JOHN HWANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA SUITE 207
LAGUNA HILLS CA
92653-3107
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA SUITE 207
LAGUNA HILLS CA
92653-3107
US

V. Phone/Fax

Practice location:
  • Phone: 949-707-5125
  • Fax:
Mailing address:
  • Phone: 949-707-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA112582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: