Healthcare Provider Details

I. General information

NPI: 1386473494
Provider Name (Legal Business Name): JEONGYI HONG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 WILSHIRE BLVD # 204
LOS ANGELES CA
90010-3704
US

IV. Provider business mailing address

4465 WILSHIRE BLVD # 204
LOS ANGELES CA
90010-3704
US

V. Phone/Fax

Practice location:
  • Phone: 213-808-7780
  • Fax:
Mailing address:
  • Phone: 213-808-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030549
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95249702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: