Healthcare Provider Details

I. General information

NPI: 1225360456
Provider Name (Legal Business Name): SOONBONG HWANG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13698 ROOSEVELT AVE
FLUSHING NY
11354-5510
US

IV. Provider business mailing address

51 DAVIS LN
ROSLYN NY
11576-2158
US

V. Phone/Fax

Practice location:
  • Phone: 718-461-5500
  • Fax: 718-461-5501
Mailing address:
  • Phone: 516-801-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051825
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: