Healthcare Provider Details

I. General information

NPI: 1922087519
Provider Name (Legal Business Name): JAUNG MIE HWANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203
US

IV. Provider business mailing address

3769 MAHLON BROWER DR
OCEANSIDE NY
11572
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-2983
  • Fax:
Mailing address:
  • Phone: 516-678-4985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number126509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: