Provider Demographics
NPI:1316965494
Name:HWANG, JIMMY HO (MD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:HO
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19943 LASSEN ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5539
Mailing Address - Country:US
Mailing Address - Phone:818-885-0588
Mailing Address - Fax:
Practice Address - Street 1:18251 ROSCOE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4200
Practice Address - Country:US
Practice Address - Phone:818-885-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38692207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A386920, 00A386921Medicaid
C35496Medicare UPIN
A38692, A38692AMedicare ID - Type Unspecified