Provider Demographics
NPI:1871856963
Name:HWANG, BONGJOO J (PHD)
Entity Type:Individual
Prefix:
First Name:BONGJOO
Middle Name:J
Last Name:HWANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:BONG JOO
Other - Middle Name:
Other - Last Name:HWANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3682 VIA BERNARDO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-7230
Mailing Address - Country:US
Mailing Address - Phone:619-786-7631
Mailing Address - Fax:
Practice Address - Street 1:5830 OBERLIN DR STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3754
Practice Address - Country:US
Practice Address - Phone:619-786-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30203103T00000X
OH6536103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling