Provider Demographics
NPI:1659634194
Name:HWANG, CAROLINE
Entity Type:Individual
Prefix:
First Name:CAROLINE
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 1:2620 EL CAMINO REAL
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1255
Mailing Address - Country:US
Mailing Address - Phone:760-720-0966
Mailing Address - Fax:
Practice Address - Street 1:2620 EL CAMINO REAL
Practice Address - Street 2:SUITE A
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1255
Practice Address - Country:US
Practice Address - Phone:734-972-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010206891223G0001X
CA63914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice