Provider Demographics
NPI:1386171106
Name:HWANG-BETAT, BOHYE SHELLY (MD)
Entity type:Individual
Prefix:
First Name:BOHYE
Middle Name:SHELLY
Last Name:HWANG-BETAT
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 1:570 S MOUNT VERNON AVE STE G
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2737
Mailing Address - Country:US
Mailing Address - Phone:423-243-4869
Mailing Address - Fax:
Practice Address - Street 1:570 S MOUNT VERNON AVE STE G
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2737
Practice Address - Country:US
Practice Address - Phone:423-243-4869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA158825208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics