Provider Demographics
NPI:1669490926
Name:HWANG, JASON (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 FLORA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6234
Mailing Address - Country:US
Mailing Address - Phone:408-940-6001
Mailing Address - Fax:888-768-6089
Practice Address - Street 1:412 FLORA VISTA AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6234
Practice Address - Country:US
Practice Address - Phone:408-940-6001
Practice Address - Fax:888-768-6089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220304207R00000X
CAA73310207R00000X
GA074485207R00000X
MI4301104580207R00000X
NY274755207R00000X
OH35.123940207R00000X
PAMD451880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H67264Medicare UPIN