=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841509049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID CHIEN-TA HWANG O.D.INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2010
-----------------------------------------------------
Last Update Date | 08/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13925 YALE AVE SUITE 130
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92620-2668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-232-8952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13925 YALE AVE SUITE 130
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92620-2668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-726-1696
-----------------------------------------------------
Fax | 949-726-1282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID CHIEN-TA HWANG
-----------------------------------------------------
Credential | O.D
-----------------------------------------------------
Telephone | 949-232-8952
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number | OPT14044TLG
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------