Provider Demographics
NPI:1235625542
Name:NG, THANHDUNG KHONG
Entity Type:Individual
Prefix:DR
First Name:THANHDUNG
Middle Name:KHONG
Last Name:NG
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:THANH
Other - Middle Name:KHONG
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:201 N COLLEGE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4614
Mailing Address - Country:US
Mailing Address - Phone:805-623-8489
Mailing Address - Fax:805-623-8513
Practice Address - Street 1:201 N COLLEGE DR STE 102
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4614
Practice Address - Country:US
Practice Address - Phone:805-623-8489
Practice Address - Fax:805-623-8513
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1023801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty