Basic Information
| Provider Information | |||||||||
| NPI: | 1033185731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HWANG | ||||||||
| FirstName: | INZUNE | ||||||||
| MiddleName: | KIM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1434 PORTER ST | ||||||||
| Address2: | |||||||||
| City: | FORT DETRICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217029254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016197175 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1434 PORTER ST | ||||||||
| Address2: | |||||||||
| City: | FORT DETRICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217029254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016197175 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38853020 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100209 | 05 | WA | MEDICAID | 0201589 | 01 | WA | DEPT LABOR AND INDUSTRY | OTHER | 1033185731 | 05 | WA | MEDICAID |