Healthcare Provider Details

I. General information

NPI: 1629262324
Provider Name (Legal Business Name): ANDREA HONG N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 E JULIAN ST
SAN JOSE CA
95116-1005
US

IV. Provider business mailing address

5671 SANTA TERESA BLVD STE 105
SAN JOSE CA
95123-6512
US

V. Phone/Fax

Practice location:
  • Phone: 408-535-6001
  • Fax: 408-535-2348
Mailing address:
  • Phone: 408-284-2281
  • Fax: 408-281-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number532018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: