Provider Demographics
NPI:1700236957
Name:HWANG, KWANG JIN
Entity Type:Individual
Prefix:
First Name:KWANG JIN
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9914 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1645
Mailing Address - Country:US
Mailing Address - Phone:714-740-7111
Mailing Address - Fax:714-733-7030
Practice Address - Street 1:9914 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1645
Practice Address - Country:US
Practice Address - Phone:714-740-7111
Practice Address - Fax:714-733-7030
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH66445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist