1629040878 NPI number — MR. CHORNG LII HWANG MD

Table of content: MR. CHORNG LII HWANG MD (NPI 1629040878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629040878 NPI number — MR. CHORNG LII HWANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HWANG
Provider First Name:
CHORNG LII
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HWANG
Provider Other First Name:
TONY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629040878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81709 DR CARREON BLVD
Provider Second Line Business Mailing Address:
B-2
Provider Business Mailing Address City Name:
INDIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-342-4771
Provider Business Mailing Address Fax Number:
760-342-2289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81709 DR CARREON BLVD
Provider Second Line Business Practice Location Address:
B-2
Provider Business Practice Location Address City Name:
INDIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-342-4771
Provider Business Practice Location Address Fax Number:
760-342-2289
Provider Enumeration Date:
02/02/2006

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: 208000000X , with the licence number:  A43799 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A437990 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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