Healthcare Provider Details

I. General information

NPI: 1538216536
Provider Name (Legal Business Name): STANLEY HONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30571 TEMECULA PKWY STE D
TEMECULA CA
92592-4821
US

IV. Provider business mailing address

30571 TEMECULA PKWY STE D
TEMECULA CA
92592-4821
US

V. Phone/Fax

Practice location:
  • Phone: 951-693-2079
  • Fax: 951-699-6720
Mailing address:
  • Phone: 951-693-2079
  • Fax: 951-699-6720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number57103
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010674
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: