Provider Demographics
NPI:1457871097
Name:HWANG, JASON J (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:J
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 1:5801 ARMY PENTAGON
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20310-5801
Mailing Address - Country:US
Mailing Address - Phone:703-692-8701
Mailing Address - Fax:
Practice Address - Street 1:5801 ARMY PENTAGON
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20310-1717
Practice Address - Country:US
Practice Address - Phone:703-692-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-25
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist