Provider Demographics
NPI:1568599165
Name:HWANG, JUSTIN DUCKSIN (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DUCKSIN
Last Name:HWANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2320
Mailing Address - Country:US
Mailing Address - Phone:323-732-5500
Mailing Address - Fax:323-732-6500
Practice Address - Street 1:3352 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2320
Practice Address - Country:US
Practice Address - Phone:323-732-5500
Practice Address - Fax:323-732-6500
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD35273Medicaid