Provider Demographics
NPI:1578614558
Name:FONG, LYNDON DAIZO (LYNDON FONG DDS MS)
Entity Type:Individual
Prefix:DR
First Name:LYNDON
Middle Name:DAIZO
Last Name:FONG
Suffix:
Gender:M
Credentials:LYNDON FONG DDS MS
Other - Prefix:DR
Other - First Name:LYNDON
Other - Middle Name:DAIZO
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LYNDON FONG DDS MS
Mailing Address - Street 1:1441 KAPIOLANI BLVD STE 616
Mailing Address - Street 2:SUITE 616
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4403
Mailing Address - Country:US
Mailing Address - Phone:808-947-3333
Mailing Address - Fax:808-947-3381
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 616
Practice Address - Street 2:SUITE 616
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4403
Practice Address - Country:US
Practice Address - Phone:808-947-3333
Practice Address - Fax:808-947-3381
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14411223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1441OtherHI ST. DENTAL LIC. #