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General NPI Number Information
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NPI Number | 1811686579
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Entity Type | Individual
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Provider Name | KONG PENG LOR
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Gender | Male
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 89 N MITCHELL AVE
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City | BAKERSVILLE
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State | NC
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Zip | 28705-6502
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Country | US
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Telephone | 828-537-5991
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Fax | 732-393-8492
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Provider Business Mailing Address
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Address Line | 86 N MITCHELL AVE
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City | BAKERSVILLE
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State | NC
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Zip | 28705-6502
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Country | US
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Telephone | 828-688-2104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14276
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License Number State | NC
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