Provider Demographics
NPI:1952468589
Name:HONG, HAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:HAN
Middle Name:
Last Name:HONG
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 1:75 VANDERBILT AVENUE
Mailing Address - Street 2:BUILDING # 7
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3850
Mailing Address - Country:US
Mailing Address - Phone:718-818-5755
Mailing Address - Fax:718-818-5756
Practice Address - Street 1:75 VANDERBILT AVENUE
Practice Address - Street 2:BUILDING # 7
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3850
Practice Address - Country:US
Practice Address - Phone:718-818-5755
Practice Address - Fax:718-818-5756
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05149911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02594250Medicaid