MEDICARE: DANIEL HWANG DMD PLLC

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	261QD0000X	Dental Clinic/Center	604-010-910	WA

General Provider Information

NPI Number	:	1487108437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL HWANG DMD PLLC

Provider Business Mailing Address
First Line	:	4825 GROVE ST
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-4474
Country	:	US
Telephone Number	:	360-659-7617
Fax Number	:

Provider Business Practice Location Address
First Line	:	4825 GROVE ST
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-4474
Country	:	US
Telephone Number	:	360-659-7617
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. DANIEL HWANG
Credential	:	DMD
Telephone Number	:	360-659-7617

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	09/08/2016

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