Provider Demographics
NPI:1760758262
Name:HUNG, ALEX PO MAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:PO MAN
Last Name:HUNG
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 1:3109 84TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1924
Mailing Address - Country:US
Mailing Address - Phone:646-577-5922
Mailing Address - Fax:
Practice Address - Street 1:3109 84TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1924
Practice Address - Country:US
Practice Address - Phone:646-577-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056920122300000X, 1223P0221X
CT11428122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03997633Medicaid