Healthcare Provider Details

I. General information

NPI: 1962762278
Provider Name (Legal Business Name): RAY HWONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FANNIN STREET SUITE MSB 5.195
HOUSTON TX
77030
US

IV. Provider business mailing address

6431 FANNIN STREET SUITE MSB 5.195
HOUSTON TX
77030-5389
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-6113
  • Fax: 713-500-0528
Mailing address:
  • Phone: 713-500-6113
  • Fax: 713-500-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberQ8727
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ8727
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberQ8727
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: