Provider Demographics
NPI:1467519876
Name:HWANG, JUNGSUN
Entity Type:Individual
Prefix:
First Name:JUNGSUN
Middle Name:
Last Name:HWANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7748 DENTON HWY
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2463
Mailing Address - Country:US
Mailing Address - Phone:817-581-2100
Mailing Address - Fax:
Practice Address - Street 1:6407 COLLEYVILLE BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6279
Practice Address - Country:US
Practice Address - Phone:817-421-1104
Practice Address - Fax:817-421-2006
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice