Henry K Pong, DDS, PSC

Primary specialty

DentistTaxonomy code 122300000X

License

54000645 Issued in IN

Legal business name

HENRY K PONG, DDS, PSC

Practice address

3820 Central Ave
Lake Station, IN 46405-2324

Phone

(219) 962-8666

NPI assigned

Sep 17, 2006

Organization subpart

No

Name

Dr. Henry K Pong, DDS

Title

President

Phone

(219) 962-8666

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mutena B. Korman, M.D.

  • General Practice Physician
  • Merrillville, IN
  • NPI 1891893491
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 19, 2013.

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361232000000",
    "number": "1174620769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3820 CENTRAL AVE",
            "city": "LAKE STATION",
            "state": "IN",
            "postal_code": "464052324",
            "telephone_number": "219-962-8666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3820 CENTRAL AVE",
            "city": "LAKE STATION",
            "state": "IN",
            "postal_code": "464052324",
            "telephone_number": "219-962-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY K PONG, DDS, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-17",
        "last_updated": "2013-02-19",
        "status": "A",
        "authorized_official_last_name": "PONG",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-962-8666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "54000645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100167920A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie-Lesly Emmanuel, MD
• Fernando H. Rivera M.D. Inc
• Kristina Kirby Flanagan, NP-BC
• Melissa Goldsberry
• Dante Ramon Golston, PHARMD
• Bruce Henry Hmurovic, D.M.D.
• Erin Nicole Hurde
• Charlene Jackson
• David Edward Jackson III, C.M.T.
• Michael Robert Johnson, R.PH.

• All providers in Lake Station, IN
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.