Provider Demographics
NPI:1093854986
Name:PETER T. HONG, D.M.D. A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:PETER T. HONG, D.M.D. A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:TZU-BIN
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-948-5600
Mailing Address - Street 1:747 ALTOS OAKS DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5433
Mailing Address - Country:US
Mailing Address - Phone:650-948-5600
Mailing Address - Fax:
Practice Address - Street 1:747 ALTOS OAKS DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5433
Practice Address - Country:US
Practice Address - Phone:650-948-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty