Provider Demographics
NPI:1619056736
Name:HONG, JUSTIN S (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:S
Last Name:HONG
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 1:665 N TUSTIN ST STE U
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7148
Mailing Address - Country:US
Mailing Address - Phone:714-744-2828
Mailing Address - Fax:714-744-2829
Practice Address - Street 1:665 N TUSTIN ST STE U
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7148
Practice Address - Country:US
Practice Address - Phone:714-744-2828
Practice Address - Fax:714-744-2829
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics