Provider Demographics
NPI:1134899396
Name:HONG, YUCHING LISA
Entity type:Individual
Prefix:DR
First Name:YUCHING
Middle Name:LISA
Last Name:HONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-4411
Mailing Address - Country:US
Mailing Address - Phone:626-216-3318
Mailing Address - Fax:626-401-3588
Practice Address - Street 1:1428 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-4411
Practice Address - Country:US
Practice Address - Phone:626-216-3318
Practice Address - Fax:626-401-3588
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty