Provider Demographics
NPI:1215160106
Name:HONG, TIFFANY LOUIE (DDS, MS)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LOUIE
Last Name:HONG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:MICHELLE
Other - Last Name:LOUIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:11040 BOLLINGER CANYON RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4969
Mailing Address - Country:US
Mailing Address - Phone:925-648-8881
Mailing Address - Fax:925-648-0488
Practice Address - Street 1:11040 BOLLINGER CANYON RD
Practice Address - Street 2:SUITE I
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4969
Practice Address - Country:US
Practice Address - Phone:925-648-8881
Practice Address - Fax:925-648-0488
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics