Provider Demographics
NPI:1477951770
Name:ANDREW H HWANG MD PROF LLC
Entity Type:Organization
Organization Name:ANDREW H HWANG MD PROF LLC
Other - Org Name:LAS VEGAS PEDIATRIC UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:H
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-728-5686
Mailing Address - Street 1:409 EMERALD HEIGHTS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4154
Mailing Address - Country:US
Mailing Address - Phone:702-728-5686
Mailing Address - Fax:702-628-9030
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 407
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-728-5686
Practice Address - Fax:702-628-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV109302Medicare PIN