Ethan Kwangwon Kong, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

14757 Issued in NC

Practice address

3020 S Miami Blvd Ste B
Durham, NC 27703-0965

Phone

(919) 246-3350

Fax

(919) 294-9628

NPI assigned

Jul 22, 2020

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Wright and Associates IX DDS PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Durham, NC
  • NPI 1194240671
  NPD (past)

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1669080958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 S MIAMI BLVD STE B",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277030965",
            "telephone_number": "919-246-3350",
            "fax_number": "919-294-9628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 S MIAMI BLVD STE B",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277030965",
            "telephone_number": "919-246-3350",
            "fax_number": "919-294-9628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONG",
        "first_name": "ETHAN",
        "middle_name": "KWANGWON",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-22",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "14757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Komkare Empowerment Center
• Carlee Komoroski, PA-C
• Meghana Konanur, MD
• Jaisheela Kondru, M.D.
• David Franklin Kong, M.D., A.M., D.M.T.
• Stefanie Kong, MD, MSPH
• Stephanie Konkel, PHARMD, BCOP
• Arvind Konkimalla, MD/PHD
• Christopher Kontos, M.D.
• Autumn Kari Konz, PA-C, MPH

• Pediatric Dentistry in Durham, NC
• Providers in Durham, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2026; 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.