Provider Demographics
NPI:1053720797
Name:HWANG, GRACE (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HWANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1010 W LA VETA AVE STE 470
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4305
Mailing Address - Country:US
Mailing Address - Phone:714-202-5682
Mailing Address - Fax:714-835-8304
Practice Address - Street 1:1010 W LA VETA AVE STE 470
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4305
Practice Address - Country:US
Practice Address - Phone:714-202-5682
Practice Address - Fax:714-835-8304
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA125505208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery