Provider Demographics
NPI:1326322256
Name:IVAN P. HWANG, M.D., INC
Entity Type:Organization
Organization Name:IVAN P. HWANG, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-754-2625
Mailing Address - Street 1:111 DEERWOOD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4409
Mailing Address - Country:US
Mailing Address - Phone:925-855-9912
Mailing Address - Fax:
Practice Address - Street 1:111 DEERWOOD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4409
Practice Address - Country:US
Practice Address - Phone:925-855-9912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty