Provider Demographics
NPI:1023734134
Name:HWANG, SHIFU PAUL (AC)
Entity type:Individual
Prefix:
First Name:SHIFU
Middle Name:PAUL
Last Name:HWANG
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SAGE CV
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-5651
Mailing Address - Country:US
Mailing Address - Phone:737-881-9481
Mailing Address - Fax:
Practice Address - Street 1:132 SAGE CV
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5651
Practice Address - Country:US
Practice Address - Phone:737-881-9481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01923171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist