Provider Demographics
NPI:1720580764
Name:HWANG, SUNGIL (PA-C)
Entity type:Individual
Prefix:
First Name:SUNGIL
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 411 BOX 3781
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112-0038
Mailing Address - Country:US
Mailing Address - Phone:314-590-3968
Mailing Address - Fax:
Practice Address - Street 1:SUDLAGER 301
Practice Address - Street 2:92249, VILSECK, GERMANY
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112-0038
Practice Address - Country:US
Practice Address - Phone:314-590-3968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000000000Medicaid