MEDICARE: ANDY HONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	A76731	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508861667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDY HONG MD

Provider Business Mailing Address
First Line	:	3625 MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE #5
City	:	LYNWOOD
State	:	CA
Zip	:	90262-3509
Country	:	US
Telephone Number	:	310-763-7504
Fax Number	:	310-763-7573

Provider Business Practice Location Address
First Line	:	3625 MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE #5
City	:	LYNWOOD
State	:	CA
Zip	:	90262-3509
Country	:	US
Telephone Number	:	310-763-7504
Fax Number	:	310-763-7573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	12/07/2010

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Practice Location Address:

3625 MARTIN LUTHER KING JR BLVD , #5
LYNWOOD, CA
90262-3509

Practice Phone: 319-763-7504
Practice Fax: 310-763-7573

Directions to “ ANDY HONG MD” Practice Location

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