MEDICARE: KRISTY HONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30068	TX
2	1223P0221X	Pediatric Dentistry	30068	TX

General Provider Information

NPI Number	:	1205242724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY HONG

Provider Business Mailing Address
First Line	:	2921 LACKLAND RD STE 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4173
Country	:	US
Telephone Number	:	817-732-2821
Fax Number	:

Provider Business Practice Location Address
First Line	:	2921 LACKLAND RD STE 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4173
Country	:	US
Telephone Number	:	817-732-2821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	10/01/2020

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Directions to “ KRISTY HONG ” Practice Location

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