Healthcare Provider Details

I. General information

NPI: 1912018219
Provider Name (Legal Business Name): JOSEPH SUNGWOOK HONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 GENETIC CENTER DR
SAN DIEGO CA
92121-6310
US

IV. Provider business mailing address

525 THIRD AVENUE
CHULA VISTA CA
91910-5696
US

V. Phone/Fax

Practice location:
  • Phone: 858-526-6155
  • Fax: 619-585-4054
Mailing address:
  • Phone: 619-585-4050
  • Fax: 619-585-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A8140
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number20A8140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: