=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932402864
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | UNSUNG HWANG PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2010
-----------------------------------------------------
Last Update Date | 12/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3990 JOHN R ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-745-8126
-----------------------------------------------------
Fax | 313-993-8627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4501 WOODWARD AVE APT # 528
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-1890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-947-6764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 5601005944
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------