Provider Demographics
NPI:1104474485
Name:HWANG, SORA
Entity type:Individual
Prefix:
First Name:SORA
Middle Name:
Last Name:HWANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8161 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6112
Mailing Address - Country:US
Mailing Address - Phone:562-418-0111
Mailing Address - Fax:
Practice Address - Street 1:8161 BARRINGTON DR
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-6112
Practice Address - Country:US
Practice Address - Phone:562-418-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023357183500000X
CA81164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist