Provider Demographics
NPI:1346951159
Name:JESSE HWANG DMD PLLC
Entity Type:Organization
Organization Name:JESSE HWANG DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-632-3000
Mailing Address - Street 1:4115 UNIVERSITY WAY NE STE 206
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6257
Mailing Address - Country:US
Mailing Address - Phone:206-632-3000
Mailing Address - Fax:
Practice Address - Street 1:100 STATE ST S STE A
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6667
Practice Address - Country:US
Practice Address - Phone:425-522-2463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty