Provider Demographics
NPI:1538378328
Name:MONG, SEAN (DDS, EDD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:MONG
Suffix:
Gender:M
Credentials:DDS, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PARNASSUS AVE
Mailing Address - Street 2:BOX 0752
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0752
Mailing Address - Country:US
Mailing Address - Phone:415-502-2471
Mailing Address - Fax:415-476-0409
Practice Address - Street 1:707 PARNASSUS AVE
Practice Address - Street 2:BOX 0752
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0752
Practice Address - Country:US
Practice Address - Phone:415-502-2471
Practice Address - Fax:415-476-0409
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice