Provider Demographics
NPI:1730142753
Name:HWANG, ANDREW H (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:409 EMERALD HEIGHTS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4154
Mailing Address - Country:US
Mailing Address - Phone:702-728-5686
Mailing Address - Fax:702-628-9030
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 407
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-728-5686
Practice Address - Fax:702-628-9030
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV118012088P0231X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002082211Medicaid
NV10955263OtherCAQH
P00360719OtherRAILROAD MEDICARE PIN
NVV107536Medicare PIN
10245Medicare PIN
P00360719OtherRAILROAD MEDICARE PIN
CAH78373Medicare UPIN