Provider Demographics
NPI:1700153566
Name:HWANG, WEN-JOU EVONNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WEN-JOU EVONNE
Middle Name:
Last Name:HWANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5656
Mailing Address - Country:US
Mailing Address - Phone:718-939-8800
Mailing Address - Fax:718-939-3386
Practice Address - Street 1:3910 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5656
Practice Address - Country:US
Practice Address - Phone:718-939-8800
Practice Address - Fax:718-939-3386
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0473011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice