MEDICARE: GREGORY ALAN HONG D.D.S.

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	034496	CA

General Provider Information

NPI Number	:	1912051905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY ALAN HONG D.D.S.

Provider Business Mailing Address
First Line	:	166 CASTLE CREST RD
Second Line	:
City	:	ALAMO
State	:	CA
Zip	:	94507-2671
Country	:	US
Telephone Number	:	925-932-8289
Fax Number	:	510-581-2321

Provider Business Practice Location Address
First Line	:	20353 LAKE CHABOT RD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5392
Country	:	US
Telephone Number	:	510-581-2102
Fax Number	:	510-581-2321

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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