Provider Demographics
NPI:1528272093
Name:HONG, BRIAN Y (DDS, MS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:Y
Last Name:HONG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2789 W OLYMPIC BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2268
Mailing Address - Country:US
Mailing Address - Phone:213-383-5437
Mailing Address - Fax:213-383-5775
Practice Address - Street 1:2789 W OLYMPIC BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2268
Practice Address - Country:US
Practice Address - Phone:213-383-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#373351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3733501Medicare UPIN