Provider Demographics
NPI:1871819391
Name:WHANG, KWANGWOO JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KWANGWOO JOSEPH
Middle Name:
Last Name:WHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 LIMONITE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-6120
Mailing Address - Country:US
Mailing Address - Phone:951-681-1565
Mailing Address - Fax:951-681-4669
Practice Address - Street 1:8175 LIMONITE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-6120
Practice Address - Country:US
Practice Address - Phone:951-681-1565
Practice Address - Fax:951-681-4669
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2625368591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice