Provider Demographics
NPI:1669527560
Name:HWANG, SHAUN K (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:K
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 1:8611 GOLF COURSE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5775
Mailing Address - Country:US
Mailing Address - Phone:505-890-6101
Mailing Address - Fax:505-890-6102
Practice Address - Street 1:8611 GOLF COURSE RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5775
Practice Address - Country:US
Practice Address - Phone:505-890-6101
Practice Address - Fax:505-890-6102
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist