Provider Demographics
NPI:1154385177
Name:HWANG, EUN-SIL SHELLEY (MD)
Entity type:Individual
Prefix:DR
First Name:EUN-SIL
Middle Name:SHELLEY
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 1:1600 DIVISADERO ST # B606
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3010
Mailing Address - Country:US
Mailing Address - Phone:415-353-7908
Mailing Address - Fax:415-353-7050
Practice Address - Street 1:1600 DIVISADERO STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-353-7111
Practice Address - Fax:415-353-7021
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76659208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G7665900Medicaid
CA0G7665900Medicare PIN
CAG79058Medicare UPIN