Healthcare Provider Details

I. General information

NPI: 1497918874
Provider Name (Legal Business Name): KYU J HWANG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 MILITARY ST SUITE 5
PORT HURON MI
48060-6692
US

IV. Provider business mailing address

2425 MILITARY ST SUITE 5
PORT HURON MI
48060-6692
US

V. Phone/Fax

Practice location:
  • Phone: 810-984-1535
  • Fax: 810-984-8320
Mailing address:
  • Phone: 810-984-1535
  • Fax: 810-984-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4301031262
License Number StateMI

VIII. Authorized Official

Name: DR. KYU J HWANG
Title or Position: OWNER
Credential: MD
Phone: 810-984-1535