Provider Demographics
NPI:1447494521
Name:HONG, DONG-SOO (DMD)
Entity type:Individual
Prefix:
First Name:DONG-SOO
Middle Name:
Last Name:HONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SUNRISE VALLEY DR STE 350
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5302
Mailing Address - Country:US
Mailing Address - Phone:703-471-4797
Mailing Address - Fax:
Practice Address - Street 1:11800 SUNRISE VALLEY DR
Practice Address - Street 2:SUITE 350
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:703-471-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10013171223P0700X
VA04014139801223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics