Healthcare Provider Details

I. General information

NPI: 1669523940
Provider Name (Legal Business Name): SONG HUN HONG D.S.S, F.A.G.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 E COMMON ST STE 205
NEW BRAUNFELS TX
78130-3173
US

IV. Provider business mailing address

1583 E COMMON ST STE 205
NEW BRAUNFELS TX
78130-3173
US

V. Phone/Fax

Practice location:
  • Phone: 830-625-2111
  • Fax: 830-620-1373
Mailing address:
  • Phone: 830-625-2111
  • Fax: 830-620-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number049426
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: