Basic Information
| Provider Information | |||||||||
| NPI: | 1760779326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HWANG | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | DA-CHANG | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | DENTAL CLINIC, DAVID GRANT MEDICAL CENTER | ||||||||
| Address2: | 101 BODIN CIR | ||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945351809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 60 MDG/SGIC | ||||||||
| Address2: | |||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074237001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 05/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | 60465 | CA | Y | Dental Providers | Dentist | Endodontics |
ID Information
| ID | Type | State | Issuer | Description | 60465 | 01 | CA | DENTAL BOARD OF CALIFORNIA | OTHER |