Golden Kong, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

107524 Issued in CA

Practice address

1404 S San Gabriel Blvd Ste a
San Gabriel, CA 91776-3632

Phone

(424) 272-1994

NPI assigned

Jun 21, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732406400000",
    "number": "1295466191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1436",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917548436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 S SAN GABRIEL BLVD STE A",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763632",
            "telephone_number": "424-272-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONG",
        "first_name": "GOLDEN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-21",
        "last_updated": "2024-11-24",
        "certification_date": "2024-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael P Klementich, RN
• George Ming Hui Ko, D.D.S.
• William Weng Ping Ko, M.D.
• Yih Jen Kok, M.D.
• Lorna Kong-Thein, M.D.
• Joseph T. Kor, D.M.D
• Elbert Kou
• Richard Eric Kratz, MD MPH
• Ethan Kruse
• Tracy Ku, D.D.S.

• General Practice Dentistry in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.