Provider Demographics
NPI:1962425603
Name:WU, HONG (MD)
Entity type:Individual
Prefix:
First Name:HONG
Middle Name:
Last Name:WU
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-728-3675
Mailing Address - Fax:215-728-2448
Practice Address - Street 1:333 COTTMAN AVENUE
Practice Address - Street 2:FOX CHASE CNACER CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-728-6900
Practice Address - Fax:215-728-2899
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063199L174400000X
PAMD063199207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018035750001Medicaid
H19053Medicare UPIN
PA0018035750001Medicaid
PA039D09HHHMedicare PIN