Provider Demographics
NPI:1962535310
Name:HO, ROBERT PHONG (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PHONG
Last Name:HO
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 1:307 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2108
Mailing Address - Country:US
Mailing Address - Phone:415-386-0666
Mailing Address - Fax:415-386-0699
Practice Address - Street 1:307 12TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2108
Practice Address - Country:US
Practice Address - Phone:415-386-0666
Practice Address - Fax:415-386-0699
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice