Provider Demographics
NPI:1689759011
Name:HONG, KELLY EUNJUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:EUNJUNG
Last Name:HONG
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 1:18031 US HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2152
Mailing Address - Country:US
Mailing Address - Phone:760-242-2338
Mailing Address - Fax:760-242-1025
Practice Address - Street 1:18031 US HIGHWAY 18
Practice Address - Street 2:STE. E
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2152
Practice Address - Country:US
Practice Address - Phone:760-242-2338
Practice Address - Fax:760-242-1025
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD53223Medicare ID - Type Unspecified