Provider Demographics
NPI:1669523940
Name:HONG, SONG HUN (DSS, FAGD)
Entity type:Individual
Prefix:
First Name:SONG
Middle Name:HUN
Last Name:HONG
Suffix:
Gender:M
Credentials:DSS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 E COMMON ST
Mailing Address - Street 2:STE 205
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3173
Mailing Address - Country:US
Mailing Address - Phone:830-625-2111
Mailing Address - Fax:830-620-1373
Practice Address - Street 1:1583 E COMMON ST
Practice Address - Street 2:STE 205
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3173
Practice Address - Country:US
Practice Address - Phone:830-625-2111
Practice Address - Fax:830-620-1373
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0494261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice