Healthcare Provider Details

I. General information

NPI: 1962139014
Provider Name (Legal Business Name): IRENE HWANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 W WHITTIER BLVD STE 200
LA HABRA CA
90631-3470
US

IV. Provider business mailing address

951 S BEACH BLVD UNIT B2025
LA HABRA CA
90631-1665
US

V. Phone/Fax

Practice location:
  • Phone: 562-690-3750
  • Fax:
Mailing address:
  • Phone: 425-623-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberCA108859
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: