Provider Demographics
NPI:1942764386
Name:HWANG, CONNIE JOY (PA)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JOY
Last Name:HWANG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16808 PICADILLY LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1772
Mailing Address - Country:US
Mailing Address - Phone:562-455-7389
Mailing Address - Fax:
Practice Address - Street 1:2241 WANKEL WAY STE A
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0191
Practice Address - Country:US
Practice Address - Phone:805-983-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
CAPA57459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant