Healthcare Provider Details

I. General information

NPI: 1740711332
Provider Name (Legal Business Name): MEAGHAN VICTORIA HONGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SCENIC DR
MODESTO CA
95350-6131
US

IV. Provider business mailing address

2000 TWILDO RD
OAKDALE CA
95361-2223
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-8400
  • Fax: 209-558-8443
Mailing address:
  • Phone: 209-568-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA169570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: