Healthcare Provider Details

I. General information

NPI: 1063613941
Provider Name (Legal Business Name): KWANG SHIN HONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 SAN DIMAS ST
BAKERSFIELD CA
93301-1407
US

IV. Provider business mailing address

393 E WALNUT ST 3RD FLOOR PHR SYSTEMS
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 800-353-5400
  • Fax:
Mailing address:
  • Phone: --
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA34007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: