MEDICARE: DR. LILY HWANG D.M.D

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	1223E0200X	Endodontics	13942	MD

General Provider Information

NPI Number	:	1861659286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILY HWANG D.M.D

Provider Business Mailing Address
First Line	:	5005 SIGNAL BELL LANE SUITE 101
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029
Country	:	US
Telephone Number	:	443-285-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 SIGNAL BELL LN STE 101
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-2607
Country	:	US
Telephone Number	:	443-285-2265
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	02/08/2013

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