Provider Demographics
NPI:1700988276
Name:HWANG, PHILLIP M (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:HWANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 BALDWIN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-4802
Mailing Address - Country:US
Mailing Address - Phone:626-337-0237
Mailing Address - Fax:626-337-7060
Practice Address - Street 1:3223 BALDWIN PARK BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-4802
Practice Address - Country:US
Practice Address - Phone:626-337-0237
Practice Address - Fax:626-337-7060
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist