Healthcare Provider Details

I. General information

NPI: 1508819947
Provider Name (Legal Business Name): THOMAS SANGCHUL HWANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 SW TERWILLIGER BLVD
PORTLAND OR
97239
US

IV. Provider business mailing address

PO BOX 4183
PORTLAND OR
97208-4183
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8311
  • Fax: 503-494-7233
Mailing address:
  • Phone: 503-494-6107
  • Fax: 503-494-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD24356
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00046261
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD00046261
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD24356
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: