Individual provider Active NPI

Heather Renee Hong, DDS

  • Periodontics
  • Denver, CO
National Provider Identifier
1235512906
Registry record updated Jan 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
203420 Issued in CO
Practice address
3690 S Yosemite St
Denver, CO 80237
Phone
(303) 695-0990
NPI assigned
Jun 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 61761 KS
Dentist 122300000X 2020031410 MO
Periodontics 1223P0300X DDS104922 CA
Periodontics 1223P0300X D11241 OR
Periodontics 1223P0300X 203420 CO Primary
Dentist 122300000X DN1856936 MA

Addresses

Primary practice location

3690 S Yosemite St
Denver, CO 80237

Mailing address

5994 S Holly St # 140
Greenwood Village, CO 80111-4221
Phone (626) 823-9740

Other practice location 1

10818 Parallel Pkwy
Kansas City, KS 66109-3649
Phone (626) 823-9740

Other names 1

  • Heather Renee Wong Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201021002591 CO Order and Referring Only - DentistPractitioner - Dentist 6406276948

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61761KSMDDentist
DN1856936MAMDDentist
2020031410MOMDDentist
DDS104922CAMDPeriodontist
203420COMDPeriodontist
D11241ORMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Altura Periodontics Periodontics PastSince Jan 17, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610236800000",
    "number": "1235512906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5994 S HOLLY ST # 140",
            "city": "GREENWOOD VILLAGE",
            "state": "CO",
            "postal_code": "801114221",
            "telephone_number": "626-823-9740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3690 S YOSEMITE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80237",
            "telephone_number": "303-695-0990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10818 Parallel Pkwy",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "KS",
            "postal_code": "661093649",
            "country_code": "US",
            "telephone_number": "626-823-9740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HONG",
        "first_name": "HEATHER",
        "middle_name": "RENEE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-30",
        "last_updated": "2021-01-10",
        "certification_date": "2021-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "61761",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2020031410",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "DDS104922",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": "D11241",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "203420",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1856936",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "WONG",
            "middle_name": "RENEE",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.