Healthcare Provider Details

I. General information

NPI: 1376254797
Provider Name (Legal Business Name): SIMON HWANG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2329
US

IV. Provider business mailing address

7455 W WASHINGTON AVE STE 160
LAS VEGAS NV
89128-4356
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-1958
  • Fax:
Mailing address:
  • Phone: 702-878-0393
  • Fax: 702-938-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0589
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: