Provider Demographics
NPI:1891894689
Name:HWANG, SOO YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:SOO YOUNG
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 1:275 ROBERTS AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8387
Mailing Address - Country:US
Mailing Address - Phone:989-732-8844
Mailing Address - Fax:
Practice Address - Street 1:825 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1592
Practice Address - Country:US
Practice Address - Phone:989-731-2201
Practice Address - Fax:989-731-2206
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048941207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI050092126OtherRAILROAD MEDICARE
MI4447615Medicaid
MI0506900422OtherBLUE SHIELD
MI0506900422OtherBLUE SHIELD
MIB49373Medicare UPIN