Provider Demographics
NPI:1215134226
Name:JUSTIN D HWANG DDS INC
Entity type:Organization
Organization Name:JUSTIN D HWANG DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-732-5500
Mailing Address - Street 1:3352 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2320
Mailing Address - Country:US
Mailing Address - Phone:323-732-5500
Mailing Address - Fax:323-732-6500
Practice Address - Street 1:3352 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2320
Practice Address - Country:US
Practice Address - Phone:323-732-5500
Practice Address - Fax:323-732-6500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUSTIN D HWANG DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-02
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB35273-02Medicaid