Healthcare Provider Details

I. General information

NPI: 1649788449
Provider Name (Legal Business Name): MS. CAROLYN YUSON HWANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10977 KNOBB AVE
MORONGO VALLEY CA
92256-9142
US

IV. Provider business mailing address

10977 KNOBB AVE
MORONGO VALLEY CA
92256-9142
US

V. Phone/Fax

Practice location:
  • Phone: 760-218-4664
  • Fax:
Mailing address:
  • Phone: 760-218-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: