Basic Information
Provider Information | |||||||||
NPI: | 1457075855 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BRIAN HWANG MD | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2805 | ||||||||
Address2: |   | ||||||||
City: | LAGUNA HILLS | ||||||||
State: | CA | ||||||||
PostalCode: | 926542805 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9495885800 | ||||||||
FaxNumber: | 9493173585 | ||||||||
Practice Location | |||||||||
Address1: | 23961 CALLE DE LA MAGDALENA STE 405 | ||||||||
Address2: |   | ||||||||
City: | LAGUNA HILLS | ||||||||
State: | CA | ||||||||
PostalCode: | 926533683 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9495885800 | ||||||||
FaxNumber: | 9493173585 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/29/2022 | ||||||||
LastUpdateDate: | 09/29/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HWANG | ||||||||
AuthorizedOfficialFirstName: | BRIAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
AuthorizedOfficialTelephone: | 9495885800 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: | 09/29/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |   |
No ID Information.