Provider Demographics
NPI:1316509797
Name:HWANG, HELEN HAEKYUNG
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:HAEKYUNG
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 1:355 E PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4570
Mailing Address - Country:US
Mailing Address - Phone:909-524-5940
Mailing Address - Fax:
Practice Address - Street 1:355 E PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-4570
Practice Address - Country:US
Practice Address - Phone:909-524-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274142164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse