Provider Demographics
NPI:1912500943
Name:HWANG, JI HOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JI HOON
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARCUS
Other - Middle Name:
Other - Last Name:HWANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARCUS HWANG
Mailing Address - Street 1:650 S GAINES ST APT 2113
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 S GAINES ST APT 2113
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4772
Practice Address - Country:US
Practice Address - Phone:425-329-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist