Healthcare Provider Details

I. General information

NPI: 1821475294
Provider Name (Legal Business Name): BYOUN JIN KWON HWANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 08/11/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PENNSYLVANIA AVE
CHARLESTON WV
25302-3351
US

IV. Provider business mailing address

800 PENNSYLVANIA AVENUE NEONATOLOGY DEPARTMENT
CHARLESTON WV
25302
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP31326
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number30421
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: