Healthcare Provider Details

I. General information

NPI: 1942653910
Provider Name (Legal Business Name): DANIEL HWANG D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24003 BOTHELL EVERETT HWY # 100
BOTHELL WA
98021-9342
US

IV. Provider business mailing address

14170 NE 183RD ST UNIT 312
WOODINVILLE WA
98072-7076
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-4428
  • Fax: 425-487-0030
Mailing address:
  • Phone: 206-579-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60729401
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: