Provider Demographics
NPI:1851463848
Name:KUNG, MING-FONG LASKI (DDS, MMSC, MPH)
Entity Type:Individual
Prefix:DR
First Name:MING-FONG
Middle Name:LASKI
Last Name:KUNG
Suffix:
Gender:M
Credentials:DDS, MMSC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 MADISON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0645
Mailing Address - Country:US
Mailing Address - Phone:916-961-3250
Mailing Address - Fax:916-961-3251
Practice Address - Street 1:6600 MADISON AVE STE 1
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0645
Practice Address - Country:US
Practice Address - Phone:916-961-3250
Practice Address - Fax:916-961-3251
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA271599686OtherTAX ID