Provider Demographics
NPI:1437987054
Name:GONG-GUY, STEPHEN ERNEST (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ERNEST
Last Name:GONG-GUY
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 1:1660 WESTWOOD DR STE H
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5100
Mailing Address - Country:US
Mailing Address - Phone:408-978-1103
Mailing Address - Fax:
Practice Address - Street 1:1660 WESTWOOD DR STE H
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5100
Practice Address - Country:US
Practice Address - Phone:408-978-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1103641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice