Provider Demographics
NPI:1578810164
Name:IM, HONG R (DDS)
Entity Type:Individual
Prefix:DR
First Name:HONG
Middle Name:R
Last Name:IM
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 1:8800 PINE FOREST RD
Mailing Address - Street 2:APT 3203
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-5309
Mailing Address - Country:US
Mailing Address - Phone:954-295-4701
Mailing Address - Fax:
Practice Address - Street 1:11808 RING DR
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-2111
Practice Address - Country:US
Practice Address - Phone:512-649-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326101223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice