Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | A68304 | CA |
NPI | 1023152378 |
---|---|
Provider Name | Dr. Ivan P Hwang |
First Address | Antioch, CA 94509-6101 |
Second Address | Antioch, CA 94509-6101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A683040 | (05) | CA |
G91394 | (02) | CA |