Active NPI
Jennifer Kong, DDS
- Pediatric Dentistry
- Fulshear, TX
National Provider Identifier
1003043688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 24723
- Practice address
- 11525 S Fry Rd Ste a
Fulshear, TX 77441-2156 - Phone
- (832) 913-6353
- NPI assigned
- Jun 22, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 24723 | TX | Primary |
Addresses
Primary practice location
11525 S Fry Rd Ste a
Fulshear, TX 77441-2156
Mailing address
11525 S Fry Rd Ste a
Fulshear, TX 77441-2156
Phone (832) 913-6353
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24723 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442448000000",
"number": "1003043688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11525 S FRY RD STE A",
"city": "FULSHEAR",
"state": "TX",
"postal_code": "774412156",
"telephone_number": "832-913-6353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11525 S FRY RD STE A",
"city": "FULSHEAR",
"state": "TX",
"postal_code": "774412156",
"telephone_number": "832-913-6353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONG",
"first_name": "JENNIFER",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-22",
"last_updated": "2015-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "24723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fulshear, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.