Provider Demographics
NPI:1285947564
Name:HONG, INHWAN (DMD)
Entity type:Individual
Prefix:DR
First Name:INHWAN
Middle Name:
Last Name:HONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CROSS ST
Mailing Address - Street 2:#102
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1670
Mailing Address - Country:US
Mailing Address - Phone:978-531-2122
Mailing Address - Fax:978-532-9562
Practice Address - Street 1:39 CROSS ST
Practice Address - Street 2:#102
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1670
Practice Address - Country:US
Practice Address - Phone:978-351-2122
Practice Address - Fax:978-352-3562
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH037901223G0001X
MADN18554101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice