Provider Demographics
NPI:1912047549
Name:HUNG, KENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:HUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E FOOTHILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1200
Mailing Address - Country:US
Mailing Address - Phone:909-624-1781
Mailing Address - Fax:909-625-9927
Practice Address - Street 1:520 E FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1200
Practice Address - Country:US
Practice Address - Phone:909-624-1781
Practice Address - Fax:909-625-9927
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD44899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist