Provider Demographics
NPI:1578773206
Name:JONG, KEVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:JONG
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 1:464 HUDSON TER
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2902
Mailing Address - Country:US
Mailing Address - Phone:914-815-5643
Mailing Address - Fax:
Practice Address - Street 1:464 HUDSON TER
Practice Address - Street 2:SUITE 205
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2902
Practice Address - Country:US
Practice Address - Phone:914-815-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02316100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist