Healthcare Provider Details

I. General information

NPI: 1851889588
Provider Name (Legal Business Name): MU JI HWANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date: 11/29/2018
Reactivation Date: 03/20/2019

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-3621
  • Fax:
Mailing address:
  • Phone: 860-972-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number076028
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number076028
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number076028
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: