Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 240401 | NY |
NPI | 1205846680 |
---|---|
Provider Name | Dr. Ki Soo Hwang |
First Address | Wayne, NJ 07470-3534 |
Second Address | Wayne, NJ 07470-3534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 18/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
240401 | NYS MEDICAL LICENSE (01) | NY |
25MA08144900 | NJ STATE MEDICAL LICENSE (01) | NJ |
I33639 | (02) | NY |