Healthcare Provider Details

I. General information

NPI: 1265904221
Provider Name (Legal Business Name): KEVIN HWANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BROADWAY
OAKLAND CA
94611-5730
US

IV. Provider business mailing address

340 ROEDER CT
SAN JOSE CA
95111-4057
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1000
  • Fax:
Mailing address:
  • Phone: 140-871-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number31143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: