Provider Demographics
NPI:1982910410
Name:KONG, AIMEE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:L
Last Name:KONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AIMEE
Other - Middle Name:L
Other - Last Name:BERNARDEZ-FU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:620 KIRKLAND WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6021
Mailing Address - Country:US
Mailing Address - Phone:425-822-2500
Mailing Address - Fax:425-288-2599
Practice Address - Street 1:620 KIRKLAND WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6021
Practice Address - Country:US
Practice Address - Phone:425-822-2500
Practice Address - Fax:425-288-2599
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 601680521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry