Provider Demographics
NPI:1104813815
Name:HWANG, DO SUNG (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:DO
Middle Name:SUNG
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:DR
Other - First Name:DO
Other - Middle Name:SUNG
Other - Last Name:HWANG
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:MD,FAAP
Mailing Address - Street 1:1704 LAFAYETTE RD
Mailing Address - Street 2:STE 4
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1071
Mailing Address - Country:US
Mailing Address - Phone:765-362-5100
Mailing Address - Fax:765-362-5171
Practice Address - Street 1:1704 LAFAYETTE RD
Practice Address - Street 2:STE 4
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1071
Practice Address - Country:US
Practice Address - Phone:765-362-5100
Practice Address - Fax:765-362-5171
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027436207K00000X, 208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100185410AMedicaid
INC25367Medicare UPIN
IN555560Medicare PIN