Provider Demographics
NPI:1710134978
Name:KONG, TEPY V
Entity Type:Individual
Prefix:DR
First Name:TEPY
Middle Name:V
Last Name:KONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 SEVEN CORNERS PL
Mailing Address - Street 2:SUITE H
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2011
Mailing Address - Country:US
Mailing Address - Phone:703-538-4630
Mailing Address - Fax:703-538-2533
Practice Address - Street 1:6408 SEVEN CORNERS PL
Practice Address - Street 2:SUITE H
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2011
Practice Address - Country:US
Practice Address - Phone:703-538-4630
Practice Address - Fax:703-538-2533
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014102801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice