Healthcare Provider Details

I. General information

NPI: 1962586883
Provider Name (Legal Business Name): STEPHAN T. HONDA, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/27/2019
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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberG069860
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHAN T HONDA I
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 323-757-2118