Provider Demographics
NPI:1093279184
Name:HWANG, SUNGSOO
Entity type:Individual
Prefix:
First Name:SUNGSOO
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2019
Mailing Address - Country:US
Mailing Address - Phone:681-209-3180
Mailing Address - Fax:
Practice Address - Street 1:629 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:WV
Practice Address - Zip Code:26505-2019
Practice Address - Country:US
Practice Address - Phone:681-209-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17906171100000X
WV96255171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist