Healthcare Provider Details

I. General information

NPI: 1558567586
Provider Name (Legal Business Name): PAUL KEEUN HWANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 SYLVANIA AVE
SYLVANIA OH
43560-9517
US

IV. Provider business mailing address

300 E LONG LAKE ROAD GREAT EXPRESSIONS DENTAL CENTERS SUITE 311
BLOOMFIELD MI
48304
US

V. Phone/Fax

Practice location:
  • Phone: 419-885-4796
  • Fax:
Mailing address:
  • Phone: 248-203-1119
  • Fax: 248-723-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number290101895
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: