Provider Demographics
NPI:1730229402
Name:JOHN KS TONG, DDS, INC.
Entity type:Organization
Organization Name:JOHN KS TONG, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KS
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-996-8000
Mailing Address - Street 1:10311 S DE ANZA BLVD
Mailing Address - Street 2:#3
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3028
Mailing Address - Country:US
Mailing Address - Phone:408-996-8000
Mailing Address - Fax:408-996-8008
Practice Address - Street 1:10311 S DE ANZA BLVD
Practice Address - Street 2:#3
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3028
Practice Address - Country:US
Practice Address - Phone:408-996-8000
Practice Address - Fax:408-996-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508943812OtherINDIVIDUAL NO.