Provider Demographics
NPI:1083766810
Name:HWANG, JESSIE Y (OD)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:Y
Last Name:HWANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2124 REINERT CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2354
Mailing Address - Country:US
Mailing Address - Phone:650-969-6768
Mailing Address - Fax:650-969-6768
Practice Address - Street 1:795 WILLOW RD BLDG 334
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2539
Practice Address - Country:US
Practice Address - Phone:650-599-3899
Practice Address - Fax:650-321-5163
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT11151TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU84051Medicare UPIN