Individual provider Active NPI

John Paul Hwang, DDS

  • Dentist
  • Troy, MI
National Provider Identifier
1215311063
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901021593 Issued in MI
Practice address
1155 East Long Lake Road
Suite #8
Troy, MI 48085-4942
Phone
(248) 689-5508
NPI assigned
Jul 10, 2015
Last updated
Nov 30, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901021593 MI Primary

Addresses

Primary practice location

1155 East Long Lake Road
Suite #8
Troy, MI 48085-4942

Mailing address

1155 East Long Lake Rod
Suite #8
Troy, MI 48085-1524
Phone (248) 689-5508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170214000347 MI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5991088163

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901021593MIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Troy Family Dentistry PLLC Dentist CurrentSince Nov 27, 2022 Accepting new patients
Bright Side Dental Southfield PLLC Past Accepting new patients

Locations

1155 E Long Lake Rd
Ste 8
Troy, MI 48085
Phone (248) 689-5508

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1215311063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 EAST LONG LAKE ROD",
            "address_2": "SUITE #8",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480851524",
            "telephone_number": "248-689-5508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 EAST LONG LAKE ROAD",
            "address_2": "SUITE #8",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480854942",
            "telephone_number": "248-689-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HWANG",
        "first_name": "JOHN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-10",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.