Provider Demographics
NPI:1073640462
Name:KONG, WAH JEW (DDS)
Entity Type:Individual
Prefix:
First Name:WAH
Middle Name:JEW
Last Name:KONG
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:PO BOX 404
Mailing Address - Street 2:2205 CLINTON DR
Mailing Address - City:GALENA PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77547
Mailing Address - Country:US
Mailing Address - Phone:713-674-0550
Mailing Address - Fax:713-674-2299
Practice Address - Street 1:2205 CLINTON DR
Practice Address - Street 2:
Practice Address - City:GALENA PARK
Practice Address - State:TX
Practice Address - Zip Code:77547
Practice Address - Country:US
Practice Address - Phone:713-674-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist