Provider Demographics
NPI:1548410350
Name:KONG, HYUNG-JUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HYUNG-JUN
Middle Name:
Last Name:KONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N. ORLANDO AVE.
Mailing Address - Street 2:SUITE 317
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2900
Mailing Address - Country:US
Mailing Address - Phone:321-972-8870
Mailing Address - Fax:321-275-5911
Practice Address - Street 1:501 N ORLANDO AVE
Practice Address - Street 2:SUITE 317
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7313
Practice Address - Country:US
Practice Address - Phone:321-972-8870
Practice Address - Fax:321-275-5911
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist