Provider Demographics
NPI:1174731467
Name:KUNG, BONNIE (DDS)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:KUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 TANGLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9028
Mailing Address - Country:US
Mailing Address - Phone:732-577-5578
Mailing Address - Fax:
Practice Address - Street 1:146 US HIGHWAY 9
Practice Address - Street 2:MARLBORO PLAZA
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8249
Practice Address - Country:US
Practice Address - Phone:732-536-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018499001223G0001X
NY044275-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice