Provider Demographics
NPI:1588183800
Name:HWANG, MIKI SUK (PMHNP)
Entity Type:Individual
Prefix:
First Name:MIKI
Middle Name:SUK
Last Name:HWANG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MIKI
Other - Middle Name:PAEK
Other - Last Name:HWANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:216 HOWARTH RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5353
Mailing Address - Country:US
Mailing Address - Phone:610-566-8322
Mailing Address - Fax:
Practice Address - Street 1:1500 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1200
Practice Address - Country:US
Practice Address - Phone:610-237-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017868363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health