Provider Demographics
NPI:1124245154
Name:HONG, SOOK (DDS)
Entity type:Individual
Prefix:MRS
First Name:SOOK
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39047 STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1433
Mailing Address - Country:US
Mailing Address - Phone:510-505-0118
Mailing Address - Fax:510-505-0174
Practice Address - Street 1:39047 STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1433
Practice Address - Country:US
Practice Address - Phone:510-505-0118
Practice Address - Fax:510-505-0174
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist