Provider Demographics
NPI:1154350569
Name:HWANG, GRACE T (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:T
Last Name:HWANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CHANNEL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7837
Mailing Address - Country:US
Mailing Address - Phone:907-463-4074
Mailing Address - Fax:907-463-1510
Practice Address - Street 1:700 KATLIAN ST STE E
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7359
Practice Address - Country:US
Practice Address - Phone:907-747-5136
Practice Address - Fax:907-747-5415
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0118739OtherMEDICA #
ND0118737OtherMEDICA #
ND0118738OtherMEDICA #
ND36339OtherLHS #
ND137093OtherUCARE #
ND2205950OtherAMERICA'S PPO/ARAZ #
NDDA9011042436OtherPREFERRED ONE #
ND24810OtherNDBS #
ND891S6HWOtherNDBS #
ND891S7HWOtherMNBS #
NDHP47433OtherHEALTHPARTNERS #
AKMD39566Medicaid
ND13198Medicaid
ND569144300Medicaid
AK8EE851Medicare PIN
ND2205950OtherAMERICA'S PPO/ARAZ #
G63013Medicare UPIN
ND891S7HWOtherMNBS #
ND569144300Medicaid
ND0118737OtherMEDICA #
ND0118738OtherMEDICA #