Healthcare Provider Details

I. General information

NPI: 1053720797
Provider Name (Legal Business Name): GRACE HWANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 470
ORANGE CA
92868-4305
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 470
ORANGE CA
92868-4305
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-5682
  • Fax: 714-835-8304
Mailing address:
  • Phone: 714-202-5682
  • Fax: 714-835-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA125505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: