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General NPI Number Information
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NPI Number | 1205846680
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Entity Type | Individual
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Provider Name | KI SOO HWANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 504 VALLEY RD 2ND FLOOR
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City | WAYNE
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State | NJ
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Zip | 07470-3534
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Country | US
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Telephone | 973-686-0700
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Fax | 973-686-0701
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Provider Business Mailing Address
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Address Line | 504 VALLEY RD 2ND FLOOR
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City | WAYNE
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State | NJ
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Zip | 07470-3534
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Country | US
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Telephone | 973-686-0700
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Fax | 973-686-0701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 240401
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License Number State | NY
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