Provider Demographics
NPI:1508479957
Name:KHONG, DANH (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANH
Middle Name:
Last Name:KHONG
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 1:8552 WESTMINSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4605
Mailing Address - Country:US
Mailing Address - Phone:714-379-1322
Mailing Address - Fax:714-379-1324
Practice Address - Street 1:8552 WESTMINSTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4605
Practice Address - Country:US
Practice Address - Phone:714-379-1322
Practice Address - Fax:714-379-1324
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1053571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice