Provider Demographics
NPI:1467582056
Name:HONG, SUSAN SEUNG-HEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SEUNG-HEE
Last Name:HONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11848 BERNARDO PLAZA COURT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5209
Mailing Address - Country:US
Mailing Address - Phone:858-247-3020
Mailing Address - Fax:858-247-3020
Practice Address - Street 1:11848 BERNARDO PLAZA COURT
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-5209
Practice Address - Country:US
Practice Address - Phone:858-247-3020
Practice Address - Fax:858-247-3040
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice