Provider Demographics
NPI:1164046207
Name:HWANG, TAE GYUNG (DDS)
Entity Type:Individual
Prefix:
First Name:TAE GYUNG
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:TAE
Other - Middle Name:
Other - Last Name:HWANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:OH
Mailing Address - Zip Code:44660-0104
Mailing Address - Country:US
Mailing Address - Phone:330-390-6006
Mailing Address - Fax:330-390-6008
Practice Address - Street 1:4581 TOWNSHIP RD 634
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654
Practice Address - Country:US
Practice Address - Phone:330-390-6006
Practice Address - Fax:330-390-6008
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0261341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice