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General NPI Number Information
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NPI Number | 1093116949
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Entity Type | Organization
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Legal Business Name | LOUIS HONG DENTAL CORPORATION
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 1714 FREEDOM BLVD
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City | FREEDOM
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State | CA
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Zip | 95019-3025
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Country | US
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Telephone | 831-768-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 1714 FREEDOM BLVD
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City | FREEDOM
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State | CA
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Zip | 95019-3025
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Country | US
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Telephone | 831-768-0707
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LOUIS HONG
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Credential |
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Telephone | 831-768-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 46266
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License Number State | CA
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