1285967653 NPI number — GUARDIAN ANGEL HEALTHCARE II, INC

Table of content: EUN KYUNG HWANG M.D. (NPI 1306938998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285967653 NPI number — GUARDIAN ANGEL HEALTHCARE II, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUARDIAN ANGEL HEALTHCARE II, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1285967653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 S HALL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39117-8057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-782-9997
Provider Business Mailing Address Fax Number:
601-732-8037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
347 MAGNOLIA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-782-9997
Provider Business Practice Location Address Fax Number:
601-732-8037
Provider Enumeration Date:
09/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
PAULETTE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-782-9997

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  16-255 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25-S163 . This is a "MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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