Provider Demographics
NPI:1124103114
Name:HWANG, PAMELA AYELEN (DDS)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:AYELEN
Last Name:HWANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:AYELEN
Other - Last Name:HWANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11459 BANGOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-478-5997
Mailing Address - Fax:
Practice Address - Street 1:2048 ORANGE TREE LANE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374
Practice Address - Country:US
Practice Address - Phone:909-793-3443
Practice Address - Fax:909-335-2225
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist