Provider Demographics
NPI:1528420056
Name:HWANGBO, HYEON (DMD)
Entity Type:Individual
Prefix:DR
First Name:HYEON
Middle Name:
Last Name:HWANGBO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:HWANGBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:313 WOODLAND PL APT 207
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1728
Mailing Address - Country:US
Mailing Address - Phone:914-703-1144
Mailing Address - Fax:
Practice Address - Street 1:412 PLEASANT VALLEY WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2988
Practice Address - Country:US
Practice Address - Phone:973-731-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0603751223P0221X
390200000X
NJ22DI027612001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program