Provider Demographics
NPI:1992873806
Name:DONG, KHAI VUDANG (DDS)
Entity type:Individual
Prefix:
First Name:KHAI
Middle Name:VUDANG
Last Name:DONG
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 1:1907 NAPLES DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1920
Mailing Address - Country:US
Mailing Address - Phone:408-904-9814
Mailing Address - Fax:
Practice Address - Street 1:1907 NAPLES DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1920
Practice Address - Country:US
Practice Address - Phone:408-904-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice