=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386917946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDS CARE DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2012
-----------------------------------------------------
Last Update Date | 10/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3315 JUNCTION BLVD STE A
-----------------------------------------------------
City | JACKSON HTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-634-0224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3315 JUNCTION BLVD
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-507-6200
-----------------------------------------------------
Fax | 718-507-5338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. SOON YOUNG HWANG
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 718-507-6200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------