Provider Demographics
NPI:1255726170
Name:KWON, HYUK SANG
Entity type:Individual
Prefix:DR
First Name:HYUK SANG
Middle Name:
Last Name:KWON
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 1:1621 W WELLS ST
Mailing Address - Street 2:APT #409
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-3204
Mailing Address - Country:US
Mailing Address - Phone:414-377-2371
Mailing Address - Fax:
Practice Address - Street 1:840 W JUNEAU AVE APT 122
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1450
Practice Address - Country:US
Practice Address - Phone:402-517-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60010281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics