DR. KONGSAB LA HATLAVONGSA DDS
NPI 1366798530
Dentist in Mendota, CA

Q: What is Kongsab Hatlavongsa's NPI number?

The NPI number for Kongsab Hatlavongsa is 1366798530. It was assigned to this individual provider in the NPPES registry on July 25, 2012.

Q: What is Kongsab Hatlavongsa's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Active since July 25, 2012PECOS Enrolled

121 BARBOZA ST, MENDOTA, CA 93640(559) 655-5000 Get Directions Write a Review

NPPES record last updated: March 25, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. Kongsab La Hatlavongsa Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KONGSAB LA HATLAVONGSA DDS (NPI 1366798530) is an individual dentist in Mendota, California, licensed in California (61581) and active in the NPI registry since July 2012. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1366798530

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameDR. KONGSAB LA HATLAVONGSACredential: DDS

Location Address121 BARBOZA STMendota, CA 93640-1901

Mailing Address3035 N Mcarthur AveFresno, CA 93727

Phone(559) 655-5000

Sole ProprietorYes

Enumeration DateJuly 25, 2012

Last NPPES UpdateMarch 25, 2014

✔ NPI 1366798530 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in CA · 61581

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

121 BARBOZA ST, Mendota, CA 93640

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kongsab La Hatlavongsa Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 93640 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.32 typical visit price

range $58.87 – $176.60

Typical copayment $22.58 (range $14.71 – $44.15)

Most-billed visit code 99203

Established Patient

$73.16 typical visit price

range $19.28 – $144.60

Typical copayment $18.29 (range $4.82 – $36.15)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BUM KIM DDS

Dentist (General Practice)