Provider Demographics
NPI:1114056801
Name:HONG, KABSUN (DDS)
Entity Type:Individual
Prefix:
First Name:KABSUN
Middle Name:
Last Name:HONG
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 1:9601 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5507
Mailing Address - Country:US
Mailing Address - Phone:562-862-5555
Mailing Address - Fax:562-862-5559
Practice Address - Street 1:9601 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5507
Practice Address - Country:US
Practice Address - Phone:562-862-5555
Practice Address - Fax:562-862-5599
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice