MEDICARE: CHIAO-TZE HWANG DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	48918	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9381701	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1053751842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIAO-TZE HWANG DDS INC

Provider Business Mailing Address
First Line	:	4700 PANAMA LN SUITE 102
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93313
Country	:	US
Telephone Number	:	661-836-8999
Fax Number	:	661-832-5285

Provider Business Practice Location Address
First Line	:	4700 PANAMA LN UNIT 102
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93313-3481
Country	:	US
Telephone Number	:	661-836-8999
Fax Number	:	661-832-5285

Authorized Official
Title or Position	:	BILLING
Name	:	VICKY ALMENGOR
Credential	:
Telephone Number	:	661-836-8999

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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