Tae Jeong Gong

NPI 1790463883 · on the registry since 2023 · sole proprietor

Practice

Address: 366 W Lake Mead Pkwy Ste 100
Henderson, NV 89015
Phone: (702) 464-3090
Organisation at this address: Khakwani Medical Corporation, Pc
Mugleston Henderson Modern Dentistry, Pc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 18

Registry record

Primary taxonomy: 1223G0001X
1223G0001X
Licence states on file: NV
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2026-06-24

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Nevada