Healthcare Provider Details

I. General information

NPI: 1922602119
Provider Name (Legal Business Name): INSUNG HWANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 11/28/2020
Certification Date: 11/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N 12TH ST # STUNITF
PHILADELPHIA PA
19122-2503
US

IV. Provider business mailing address

213 MAPLE AVE APT K165
HORSHAM PA
19044-3330
US

V. Phone/Fax

Practice location:
  • Phone: 215-235-2001
  • Fax:
Mailing address:
  • Phone: 267-266-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454962
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: