Provider Demographics
NPI:1205846680
Name:HWANG, KI SOO (MD)
Entity Type:Individual
Prefix:DR
First Name:KI
Middle Name:SOO
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:504 VALLEY RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3534
Mailing Address - Country:US
Mailing Address - Phone:973-686-0700
Mailing Address - Fax:973-686-0701
Practice Address - Street 1:504 VALLEY RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3534
Practice Address - Country:US
Practice Address - Phone:973-686-0700
Practice Address - Fax:973-686-0701
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY240401207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY240401OtherNYS MEDICAL LICENSE
NJ25MA08144900OtherNJ STATE MEDICAL LICENSE
NJ25MA08144900OtherNJ STATE MEDICAL LICENSE
NJ128017Y2HMedicare PIN