Individual
ETHAN KWANGWON KONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3020 S MIAMI BLVD STE B, DURHAM, NC 27703-0965
(919) 246-3350
(919) 294-9628
Mailing address
3020 S MIAMI BLVD STE B, DURHAM, NC 27703-0965
(919) 246-3350
(919) 294-9628
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
14757
NC
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/22/2020
Last updated
06/05/2026
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