Provider Demographics
NPI:1497918874
Name:KYU J HWANG MD PC
Entity Type:Organization
Organization Name:KYU J HWANG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYU
Authorized Official - Middle Name:J
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-984-1535
Mailing Address - Street 1:2425 MILITARY ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6692
Mailing Address - Country:US
Mailing Address - Phone:810-984-1535
Mailing Address - Fax:810-984-8320
Practice Address - Street 1:2425 MILITARY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6692
Practice Address - Country:US
Practice Address - Phone:810-984-1535
Practice Address - Fax:810-984-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031262207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101063088Medicaid
MI101063088Medicaid
MIP50156Medicare UPIN