Provider Demographics
NPI:1922375070
Name:RONG, HAO (DDS)
Entity Type:Individual
Prefix:MR
First Name:HAO
Middle Name:
Last Name:RONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 COMMODORE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1112
Mailing Address - Country:US
Mailing Address - Phone:408-528-4370
Mailing Address - Fax:
Practice Address - Street 1:1722 COMMODORE DR.
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133
Practice Address - Country:US
Practice Address - Phone:408-528-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27453OtherDENTAL LICENSE
CA60308OtherCALIFORNIA DENTAL LICENSE