MEDICARE: DR. KWANGWOO JOSEPH WHANG DMD

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	1223G0001X	General Practice Dentistry	262536859	CA

General Provider Information

NPI Number	:	1871819391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWANGWOO JOSEPH WHANG DMD

Provider Business Mailing Address
First Line	:	8175 LIMONITE AVE
Second Line	:	SUITE D
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-6120
Country	:	US
Telephone Number	:	951-681-1565
Fax Number	:	951-681-4669

Provider Business Practice Location Address
First Line	:	8175 LIMONITE AVE
Second Line	:	SUITE D
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-6120
Country	:	US
Telephone Number	:	951-681-1565
Fax Number	:	951-681-4669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	04/08/2010

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