Provider Demographics
NPI:1518096858
Name:PONG, CHRISTINE GIT LIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:GIT LIN
Last Name:PONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N KING ST STE 111
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4649
Mailing Address - Country:US
Mailing Address - Phone:808-848-2400
Mailing Address - Fax:808-847-2238
Practice Address - Street 1:555 N KING ST STE 111
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4649
Practice Address - Country:US
Practice Address - Phone:808-848-2400
Practice Address - Fax:808-847-2238
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-22711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI227101OtherHDS
HI58677901Medicaid