Provider Demographics
NPI:1679918007
Name:JAE HONG DDS, PLLC
Entity type:Organization
Organization Name:JAE HONG DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-243-3300
Mailing Address - Street 1:429 SW 153RD ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2214
Mailing Address - Country:US
Mailing Address - Phone:206-243-3300
Mailing Address - Fax:206-243-7500
Practice Address - Street 1:429 SW 153RD ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2214
Practice Address - Country:US
Practice Address - Phone:206-243-3300
Practice Address - Fax:206-243-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA82271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty