Provider Demographics
NPI:1093358533
Name:WHANG, JI HYE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:HYE
Last Name:WHANG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POLE PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1740
Mailing Address - Country:US
Mailing Address - Phone:310-508-0121
Mailing Address - Fax:
Practice Address - Street 1:25 POLE PLAIN RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1740
Practice Address - Country:US
Practice Address - Phone:310-508-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2321572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily