Provider Demographics
NPI:1679297238
Name:HWANG, INCHAN (PA)
Entity type:Individual
Prefix:
First Name:INCHAN
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
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:PO BOX 5730
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:888-402-7256
Mailing Address - Fax:
Practice Address - Street 1:18818 MEISNER DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3568
Practice Address - Country:US
Practice Address - Phone:210-481-6800
Practice Address - Fax:210-481-1444
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX751902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant