Provider Demographics
NPI:1639252364
Name:HONG, YOUNGGI (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOUNGGI
Middle Name:
Last Name:HONG
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 1:5274 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4781
Mailing Address - Country:US
Mailing Address - Phone:614-794-4000
Mailing Address - Fax:614-794-0832
Practice Address - Street 1:5274 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4781
Practice Address - Country:US
Practice Address - Phone:614-794-4000
Practice Address - Fax:614-794-0832
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0221711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2590245Medicaid