Provider Demographics
NPI:1518578194
Name:KHONG, GINA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:KHONG
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 1:4300 DUNLAVY ST APT 2135
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5404
Mailing Address - Country:US
Mailing Address - Phone:817-683-9110
Mailing Address - Fax:
Practice Address - Street 1:333 N RIVERSHIRE DR STE 280
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2799
Practice Address - Country:US
Practice Address - Phone:936-756-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice