Provider Demographics
NPI:1528120797
Name:TONG, HONGSHENG SAM (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:HONGSHENG
Middle Name:SAM
Last Name:TONG
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20360 VIA MANRESA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3209
Mailing Address - Country:US
Mailing Address - Phone:714-779-1392
Mailing Address - Fax:
Practice Address - Street 1:11705 SLATE AVE STE 150
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7119
Practice Address - Country:US
Practice Address - Phone:951-689-8021
Practice Address - Fax:951-689-8025
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics