Provider Demographics
NPI:1255561361
Name:HONG, SUE-YOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:SUE-YOUNG
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5976 HOWDERSHELL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-4106
Mailing Address - Country:US
Mailing Address - Phone:314-731-0470
Mailing Address - Fax:314-731-0473
Practice Address - Street 1:5976 HOWDERSHELL RD STE 207
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-4106
Practice Address - Country:US
Practice Address - Phone:314-731-0470
Practice Address - Fax:314-731-0473
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090070921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics