Provider Demographics
NPI:1598004954
Name:HONGO, PAUL JOSEPH
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:HONGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 TENNYSON ST UNIT 12375
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-4415
Mailing Address - Country:US
Mailing Address - Phone:720-305-6689
Mailing Address - Fax:720-358-5897
Practice Address - Street 1:3700 TENNYSON ST
Practice Address - Street 2:# 12375
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-4415
Practice Address - Country:US
Practice Address - Phone:720-305-6689
Practice Address - Fax:720-358-5897
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO6633363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health