Provider Demographics
NPI:1619181070
Name:DONG, MOO GIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOO
Middle Name:GIL
Last Name:DONG
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 1:14325 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3242
Mailing Address - Country:US
Mailing Address - Phone:626-962-6814
Mailing Address - Fax:626-960-4227
Practice Address - Street 1:14325 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3242
Practice Address - Country:US
Practice Address - Phone:626-962-6814
Practice Address - Fax:626-960-4227
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist