Healthcare Provider Details

I. General information

NPI: 1295936615
Provider Name (Legal Business Name): STEPHAN T HONDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W EL SEGUNDO BLVD
HAWTHORNE CA
90250-3315
US

IV. Provider business mailing address

2301 W EL SEGUNDO BLVD
HAWTHORNE CA
90250-3315
US

V. Phone/Fax

Practice location:
  • Phone: 323-757-2118
  • Fax:
Mailing address:
  • Phone: 323-757-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG6986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: