Provider Demographics
NPI:1770005894
Name:HWANG, DANIEL SUKWOO
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SUKWOO
Last Name:HWANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 DACULA RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2136
Mailing Address - Country:US
Mailing Address - Phone:678-407-2757
Mailing Address - Fax:678-376-3728
Practice Address - Street 1:635 DACULA RD STE 105
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2136
Practice Address - Country:US
Practice Address - Phone:678-407-2757
Practice Address - Fax:678-376-3728
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist