=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881944114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISMILE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2012
-----------------------------------------------------
Last Update Date | 09/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6434 HIGHWAY 6 N
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-682-1600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 BISSONNET ST APT 5307
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77005-4092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-261-8311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MYOUNG HWANG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 713-261-8311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 27905
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------