Healthcare Provider Details

I. General information

NPI: 1548902281
Provider Name (Legal Business Name): GLORIA JIWON HONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 CENTURY PARK E
LOS ANGELES CA
90067-1907
US

IV. Provider business mailing address

8700 BEVERLY BLVD LOS ANGLES
WEST HOLLYWOOD CA
90048-1804
US

V. Phone/Fax

Practice location:
  • Phone: 424-522-7100
  • Fax: 424-522-7234
Mailing address:
  • Phone: 424-522-7100
  • Fax: 424-522-7234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA190256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: