MEDICARE: DR. MICHAEL K HWANG DMD

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	009577	CT
2	1223G0001X	General Practice Dentistry	9577	CT

General Provider Information

NPI Number	:	1568685352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL K HWANG DMD

Provider Business Mailing Address
First Line	:	1175 MAIN ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-2245
Country	:	US
Telephone Number	:	860-528-3427
Fax Number	:	860-528-4477

Provider Business Practice Location Address
First Line	:	1175 MAIN ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-2245
Country	:	US
Telephone Number	:	860-528-3427
Fax Number	:	860-528-4477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/19/2013

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