MEDICARE: JUSTIN D. HWANG, DDS, INC

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	1223G0001X	General Practice Dentistry	35273	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508061524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSTIN D. HWANG, DDS, INC

Provider Business Mailing Address
First Line	:	7208 PACIFIC BLVD STE 200
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5770
Country	:	US
Telephone Number	:	323-582-2200
Fax Number	:	323-582-2882

Provider Business Practice Location Address
First Line	:	7208 PACIFIC BLVD STE 200
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5770
Country	:	US
Telephone Number	:	323-582-2200
Fax Number	:	323-582-2882

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUSTIN D HWANG
Credential	:	D.D.S
Telephone Number	:	323-582-2200

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	10/14/2010

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