MEDICARE: KOREANESE DENTAL IMPLANT CENTER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	27905	TX

General Provider Information

NPI Number	:	1134586225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOREANESE DENTAL IMPLANT CENTER, PA

Provider Business Mailing Address
First Line	:	11415 BELLAIRE BLVD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77072-2572
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11415 BELLAIRE BLVD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77072-2572
Country	:	US
Telephone Number	:	832-770-7777
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MYOUNG HWANG
Credential	:	DDS
Telephone Number	:	832-770-7777

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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