=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225192115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KY & HONG DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 11/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9601 FIRESTONE BLVD
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-5507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-862-5555
-----------------------------------------------------
Fax | 562-862-5599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9601 FIRESTONE BLVD
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-5507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-862-5555
-----------------------------------------------------
Fax | 562-862-5599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KABSUN HONG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 562-862-5555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 41938
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 41922
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------