Healthcare Provider Details

I. General information

NPI: 1689948044
Provider Name (Legal Business Name): OSTEOPATHIC SPORTS & WELLNESS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE SUITE 125
LA JOLLA CA
92037-1269
US

IV. Provider business mailing address

9834 GENESEE AVE SUITE 125
LA JOLLA CA
92037-1269
US

V. Phone/Fax

Practice location:
  • Phone: 858-720-1565
  • Fax:
Mailing address:
  • Phone: 858-720-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number20A8140
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH SUNGWOOK HONG
Title or Position: PRESIDENT/PROVIDER
Credential: D.O.
Phone: 858-720-1565