Provider Demographics
NPI:1346500519
Name:LIEW DMD, ENN KONG
Entity Type:Individual
Prefix:
First Name:ENN KONG
Middle Name:
Last Name:LIEW DMD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13-17 ELIZABETH STREET
Mailing Address - Street 2:STE 305
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-925-8171
Mailing Address - Fax:
Practice Address - Street 1:13-17 ELIZABETH STREET
Practice Address - Street 2:STE 305
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-925-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist