Provider Demographics
NPI:1164143947
Name:KONG, JONG HOON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONG HOON
Middle Name:
Last Name:KONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MONGOOSE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1055
Mailing Address - Country:US
Mailing Address - Phone:562-553-2399
Mailing Address - Fax:
Practice Address - Street 1:14415 CULVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0305
Practice Address - Country:US
Practice Address - Phone:949-733-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist