Healthcare Provider Details

I. General information

NPI: 1376529263
Provider Name (Legal Business Name): GEUMJOO HWANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 12/14/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

4732 T ST
SACRAMENTO CA
95819-4746
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-4427
  • Fax: 916-973-5826
Mailing address:
  • Phone: 916-548-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberA89119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: