Basic Information
| Provider Information | |||||||||
| NPI: | 1154350569 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HWANG | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 CHANNEL DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998017837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074634074 | ||||||||
| FaxNumber: | 9074631510 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 KATLIAN ST STE E | ||||||||
| Address2: | |||||||||
| City: | SITKA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998357359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077475136 | ||||||||
| FaxNumber: | 9077475415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3956 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0118739 | 01 | ND | MEDICA # | OTHER | 0118737 | 01 | ND | MEDICA # | OTHER | 0118738 | 01 | ND | MEDICA # | OTHER | 36339 | 01 | ND | LHS # | OTHER | 137093 | 01 | ND | UCARE # | OTHER | 2205950 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | DA9011042436 | 01 | ND | PREFERRED ONE # | OTHER | 24810 | 01 | ND | NDBS # | OTHER | 891S6HW | 01 | ND | NDBS # | OTHER | 891S7HW | 01 | ND | MNBS # | OTHER | HP47433 | 01 | ND | HEALTHPARTNERS # | OTHER | MD39566 | 05 | AK | MEDICAID | 13198 | 05 | ND | MEDICAID | 569144300 | 05 | ND | MEDICAID |