MEDICARE: KENT HUNG DMD DENTISTRY INC

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	D44899	CA

General Provider Information

NPI Number	:	1467702886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT HUNG DMD DENTISTRY INC

Provider Business Mailing Address
First Line	:	520 E FOOTHILL BLVD STE B
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-1200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 E FOOTHILL BLVD STE B
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-1200
Country	:	US
Telephone Number	:	909-624-1781
Fax Number	:	909-625-9927

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENT HUNG
Credential	:
Telephone Number	:	909-624-1781

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/13/2012

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