Provider Demographics
NPI:1952683724
Name:HONG, KEE-JU (DDS)
Entity Type:Individual
Prefix:
First Name:KEE-JU
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 1:1127 S 15TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-3139
Mailing Address - Country:US
Mailing Address - Phone:402-203-7847
Mailing Address - Fax:
Practice Address - Street 1:702 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-5124
Practice Address - Country:US
Practice Address - Phone:402-291-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69901223G0001X
NMDD43421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice