Provider Demographics
NPI:1104133792
Name:DR HONG'S MEDICAL PC
Entity type:Organization
Organization Name:DR HONG'S MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:KWANG
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-5252
Mailing Address - Street 1:14205 ROOSEVELT AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6005
Mailing Address - Country:US
Mailing Address - Phone:718-886-5252
Mailing Address - Fax:718-539-0677
Practice Address - Street 1:14205 ROOSEVELT AVE STE 109
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6005
Practice Address - Country:US
Practice Address - Phone:718-886-5252
Practice Address - Fax:718-539-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200108261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty