Provider Demographics
NPI:1306920616
Name:HONG, JERALD M (DDS)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:M
Last Name:HONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 EL CERRITO DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2110
Mailing Address - Country:US
Mailing Address - Phone:805-496-6696
Mailing Address - Fax:805-480-9735
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:SUITE 190
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6435
Practice Address - Country:US
Practice Address - Phone:805-480-9820
Practice Address - Fax:805-480-9735
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice