Provider Demographics
NPI:1275937294
Name:HWANG, JISUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JISUN
Middle Name:
Last Name:HWANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921-302 GUNYOUNG VILLA
Mailing Address - Street 2:YATAP
Mailing Address - City:SEOUNGNAM SI
Mailing Address - State:KYOUNGKI DO
Mailing Address - Zip Code:463836
Mailing Address - Country:KR
Mailing Address - Phone:0107-471-3365
Mailing Address - Fax:
Practice Address - Street 1:USAMEDDAC-K
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:US
Practice Address - Phone:0107-471-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD198951835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist