Provider Demographics
NPI:1598947913
Name:HO, MONGLAN (DDS)
Entity Type:Individual
Prefix:
First Name:MONGLAN
Middle Name:
Last Name:HO
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 1:16027 BROOKHURST ST STE J
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1551
Mailing Address - Country:US
Mailing Address - Phone:714-839-2211
Mailing Address - Fax:206-203-2210
Practice Address - Street 1:16027 BROOKHURST ST STE J
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1551
Practice Address - Country:US
Practice Address - Phone:714-839-2211
Practice Address - Fax:206-203-2210
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist