Provider Demographics
NPI:1093116949
Name:LOUIS HONG DENTAL CORPORATION
Entity Type:Organization
Organization Name:LOUIS HONG DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-768-0707
Mailing Address - Street 1:1714 FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3025
Mailing Address - Country:US
Mailing Address - Phone:831-768-0707
Mailing Address - Fax:
Practice Address - Street 1:1714 FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3025
Practice Address - Country:US
Practice Address - Phone:831-768-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46266261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental