Provider Demographics
NPI:1780421842
Name:XIONG, MOAH KONG (DDS)
Entity type:Individual
Prefix:
First Name:MOAH KONG
Middle Name:
Last Name:XIONG
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 1:726 MOORLAND RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2157
Mailing Address - Country:US
Mailing Address - Phone:715-297-6506
Mailing Address - Fax:
Practice Address - Street 1:140 N CITY STATION DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-4642
Practice Address - Country:US
Practice Address - Phone:608-837-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001557-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty