ETHAN KWANGWON KONG DDS
NPI 1669080958
Dentist - Pediatric Dentistry in Durham, NC

Q: What is Ethan Kong's NPI number?

The NPI number for Ethan Kong is 1669080958. It was assigned to this individual provider in the NPPES registry on July 22, 2020.

Q: What is Ethan Kong's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Q: When was this NPI record last updated?

The NPPES record for Ethan Kong was last updated on June 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 22, 2020PECOS Enrolled

3020 S MIAMI BLVD STE B, DURHAM, NC 27703(919) 246-3350(919) 294-9628 Get Directions Write a Review

NPPES record last updated: June 5, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jun 5, 2026, Jun 3, 2024, Jul 22, 2020 (3 updates tracked since 2020).

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About Ethan Kwangwon Kong Dds NPPES

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

ETHAN KWANGWON KONG DDS (NPI 1669080958) is an individual pediatric dentistry provider in Durham, North Carolina, licensed in North Carolina (14757) and active in the NPI registry since July 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1669080958

Entity TypeIndividualMale

Primary Taxonomy1223P0221X

Provider Legal NameETHAN KWANGWON KONGCredential: DDS

Location Address3020 S MIAMI BLVD STE BDurham, NC 27703-0965

Mailing Address3020 S Miami Blvd Ste BDurham, NC 27703-0965 · (919) 246-3350 · Fax (919) 294-9628

Phone(919) 246-3350

Fax(919) 294-9628

Sole ProprietorYes

Enumeration DateJuly 22, 2020

Last NPPES UpdateJune 5, 20263 updates tracked since enumeration

NPPES CertifiedJune 5, 2026

✔ NPI 1669080958 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

License✔ Licensed in NC · 14757

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

3020 S MIAMI BLVD STE B, Durham, NC 27703

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma 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)

Ethan Kwangwon Kong 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 27703 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

$83.90 typical visit price

range $54.12 – $165.09

Typical copayment $20.97 (range $13.53 – $41.27)

Most-billed visit code 99203

Established Patient

$67.72 typical visit price

range $17.21 – $134.61

Typical copayment $16.93 (range $4.30 – $33.65)

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

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

WRIGHT AND ASSOCIATES IX DDS PA

Dentist (Oral and Maxillofacial Surgery)

3020 S MIAMI BLVD STE B
DURHAM, NC 27703

Durham County (919) 246-3350

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Kong's NPI number?

The NPI number for Ethan Kong is 1669080958. It was assigned to this individual provider in the NPPES registry on July 22, 2020.

Where is Ethan Kong located?

Ethan Kong practices at 3020 S Miami Blvd Ste B, Durham, NC 27703. The listed phone number is (919) 246-3350.

What is Ethan Kong's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Ethan Kong enrolled in Medicare?

Yes. Ethan Kong is registered in the Medicare PECOS enrollment system.

What insurance does Ethan Kong accept?

Health plans from Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Florida Combined Life and 3 other insurers list Ethan Kong as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ethan Kong was last updated on June 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.