Active NPI
Gregory Lawrence Kong, D.D.S.
- General Practice Dentistry
- San Leandro, CA
National Provider Identifier
1629169123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 25925
- Practice address
- 151 Callan Ave
Suite 302
San Leandro, CA 94577-4536 - Phone
- (510) 351-7130
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 25925 | CA | Primary |
Addresses
Primary practice location
151 Callan Ave
Suite 302
San Leandro, CA 94577-4536
Mailing address
545 Barbara Way
Hillsborough, CA 94010-6703
Phone (650) 343-6678
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25925 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629169123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 BARBARA WAY",
"city": "HILLSBOROUGH",
"state": "CA",
"postal_code": "940106703",
"telephone_number": "650-343-6678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 CALLAN AVE",
"address_2": "SUITE 302",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774536",
"telephone_number": "510-351-7130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONG",
"first_name": "GREGORY",
"middle_name": "LAWRENCE",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "25925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.