Provider Demographics
NPI:1326058637
Name:VANG, KONG (DMD)
Entity Type:Individual
Prefix:MR
First Name:KONG
Middle Name:
Last Name:VANG
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 1:8830 KENSINGTON FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-5612
Mailing Address - Country:US
Mailing Address - Phone:704-533-2511
Mailing Address - Fax:
Practice Address - Street 1:9621 BROOKDALE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8725
Practice Address - Country:US
Practice Address - Phone:704-500-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice