Provider Demographics
NPI:1629090501
Name:RICHARD J HWANG MD PC
Entity type:Organization
Organization Name:RICHARD J HWANG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-490-6500
Mailing Address - Street 1:2022 OPITZ BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3306
Mailing Address - Country:US
Mailing Address - Phone:703-490-6500
Mailing Address - Fax:703-490-4564
Practice Address - Street 1:2022 OPITZ BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3306
Practice Address - Country:US
Practice Address - Phone:703-490-6500
Practice Address - Fax:703-490-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041789207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5901031Medicaid
G63231Medicare UPIN
VA5901031Medicaid