Healthcare Provider Details

I. General information

NPI: 1972282077
Provider Name (Legal Business Name): RICHARD Y HONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 10/31/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SUSSEX ST UNIT 617
HACKENSACK NJ
07601-4074
US

IV. Provider business mailing address

22 SUSSEX ST UNIT 617
HACKENSACK NJ
07601-4074
US

V. Phone/Fax

Practice location:
  • Phone: 714-262-3088
  • Fax:
Mailing address:
  • Phone: 714-262-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI02988500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number063370
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: