Ethan Kwangwon Kong, DDS
NPI 1669080958ActiveIndividual· Dentist, Pediatric Dentistry· Durham, NC
Dentist, Pediatric Dentistry (DDS) in Durham, North Carolina, licensed in NC, with an NPI issued in July 2020. Enrolled in Medicare as order and referring only - dentist.
Overview
| NPI | 1669080958 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DDS |
| Sole proprietor | Yes |
| NPI issued | Jul 22, 2020 |
| Last updated in NPPES | Jun 5, 2026 |
| Certified by provider | Jun 5, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Pediatric Dentistry Primary | 1223P0221X | 14757 | NC |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Order and Referring Only - Dentist (NC) |
|---|
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
Other pediatric dentists in Durham
- 1548035546
- 1548553589
- 1558175026
- 1720465354
- 1801036801
- 1811710999
- 1831416593
- 1902218902
- 1902289648
- 1972924330
- 1033261615
- 1427066349
All 16 pediatric dentists in Durham · All pediatric dentists in North Carolina