Provider Demographics
NPI:1386473494
Name:HONG, JEONGYI (FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JEONGYI
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 WILSHIRE BLVD # 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3704
Mailing Address - Country:US
Mailing Address - Phone:213-808-7780
Mailing Address - Fax:
Practice Address - Street 1:4465 WILSHIRE BLVD # 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3704
Practice Address - Country:US
Practice Address - Phone:213-808-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95249702163W00000X
CA95030549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse