Provider Demographics
NPI:1316141815
Name:HONG, JANE H (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:H
Last Name:HONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 DWIGHT WAY
Mailing Address - Street 2:SUITE 4190
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2608
Mailing Address - Country:US
Mailing Address - Phone:510-204-4635
Mailing Address - Fax:510-204-3060
Practice Address - Street 1:2001 DWIGHT WAY
Practice Address - Street 2:SUITE 4190
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-204-4635
Practice Address - Fax:510-204-3060
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA845742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400067131OtherMEDICARE GROUP NUMBER J100044293
NYJ400067128/GP 70008AMedicare PIN
NYJ400067131OtherMEDICARE GROUP NUMBER J100044293