Provider Demographics
NPI:1780846279
Name:HWANG, AMY KETCHAM (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KETCHAM
Last Name:HWANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SHANNON
Other - Last Name:KETCHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1500 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4019
Mailing Address - Country:US
Mailing Address - Phone:915-532-6935
Mailing Address - Fax:
Practice Address - Street 1:1500 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4019
Practice Address - Country:US
Practice Address - Phone:915-532-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123578207Y00000X
PAMD457154207Y00000X
WV28326207Y00000X
MN68440207Y00000X
TXU2076207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology