Basic Information
| Provider Information | |||||||||
| NPI: | 1447303318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HWANG | ||||||||
| FirstName: | SANG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 26TH ST NW APT 6312 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173499007 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8505 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301342414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704896735 | ||||||||
| FaxNumber: | 8508372042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN013209 | GA | Y | Dental Providers | Dentist | General Practice |
No ID Information.