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1669080958
ETHAN KWANGWON KONG
NEW HAVEN, CT
NPI
1669080958
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2020-07-22
Last Update Date
2024-06-03
Business Address
ETHAN KWANGWON KONG DDS
20 YORK ST
NEW HAVEN, CT 06510-3220
Phone number: 203-688-4242
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Mailing Address
ETHAN KWANGWON KONG DDS
20 YORK ST
NEW HAVEN, CT 06510-3220
Phone number: 203-688-4242
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