Provider Demographics
NPI:1861030272
Name:KELLY E. HONG, DDS, INC.
Entity Type:Organization
Organization Name:KELLY E. HONG, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:EUNJUNG
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-242-2338
Mailing Address - Street 1:12120 RIDGECREST RD STE 203
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5906
Mailing Address - Country:US
Mailing Address - Phone:760-242-2338
Mailing Address - Fax:760-684-4800
Practice Address - Street 1:12120 RIDGECREST RD STE 203
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5906
Practice Address - Country:US
Practice Address - Phone:760-242-2338
Practice Address - Fax:760-684-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty