Healthcare Provider Details

I. General information

NPI: 1902642101
Provider Name (Legal Business Name): SEUNG HOON HWANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 FREDERICK AVE
SAINT JOSEPH MO
64506-3156
US

IV. Provider business mailing address

4015 FREDERICK AVE
SAINT JOSEPH MO
64506-3156
US

V. Phone/Fax

Practice location:
  • Phone: 816-208-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2024025024
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: