Provider Demographics
NPI:1811951965
Name:HONG, KISUNG STEVE (MD)
Entity type:Individual
Prefix:DR
First Name:KISUNG
Middle Name:STEVE
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KI
Other - Middle Name:SUNG
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:140 SW 146TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1912
Mailing Address - Country:US
Mailing Address - Phone:206-630-3000
Mailing Address - Fax:206-630-3001
Practice Address - Street 1:140 SW 146TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1912
Practice Address - Country:US
Practice Address - Phone:206-630-3000
Practice Address - Fax:206-630-3001
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI23622Medicare UPIN