Provider Demographics
NPI:1104348960
Name:HWANG, HOCHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:HOCHAN
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 E PUTNAM AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1431
Mailing Address - Country:US
Mailing Address - Phone:203-637-1115
Mailing Address - Fax:203-637-1115
Practice Address - Street 1:1212 E PUTNAM AVE STE 2
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1431
Practice Address - Country:US
Practice Address - Phone:203-637-1115
Practice Address - Fax:203-637-0848
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty