Healthcare Provider Details

I. General information

NPI: 1114018868
Provider Name (Legal Business Name): SYDNEY HONG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11426 RATLIFFE ST
NORWALK CA
90650-2781
US

IV. Provider business mailing address

11426 RATLIFFE ST
NORWALK CA
90650-2781
US

V. Phone/Fax

Practice location:
  • Phone: 714-891-1550
  • Fax: 714-897-3596
Mailing address:
  • Phone: 714-891-1550
  • Fax: 714-897-3596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: