1154350569 NPI number — GRACE T HWANG MD

Table of content: GRACE T HWANG MD (NPI 1154350569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154350569 NPI number — GRACE T HWANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HWANG
Provider First Name:
GRACE
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154350569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 CHANNEL DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNEAU
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99801-7837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-463-4074
Provider Business Mailing Address Fax Number:
907-463-1510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 KATLIAN ST STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SITKA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99835-7359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-747-5136
Provider Business Practice Location Address Fax Number:
907-747-5415
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  3956 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0118739 . This is a "MEDICA #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 0118737 . This is a "MEDICA #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 0118738 . This is a "MEDICA #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 36339 . This is a "LHS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 137093 . This is a "UCARE #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 2205950 . This is a "AMERICA'S PPO/ARAZ #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: DA9011042436 . This is a "PREFERRED ONE #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 24810 . This is a "NDBS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 891S6HW . This is a "NDBS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 891S7HW . This is a "MNBS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: HP47433 . This is a "HEALTHPARTNERS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: MD39566 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13198 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 569144300 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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