Healthcare Provider Details

I. General information

NPI: 1104646611
Provider Name (Legal Business Name): MUNG GI HONG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID HONG

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 SATURN AVE STE 220280
HUNTINGTON PARK CA
90255-4377
US

IV. Provider business mailing address

2680 SATURN AVE STE 220280
HUNTINGTON PARK CA
90255-4377
US

V. Phone/Fax

Practice location:
  • Phone: 323-908-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number65236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: