Healthcare Provider Details

I. General information

NPI: 1942305099
Provider Name (Legal Business Name): RAYMOND JOONKI HONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S MELROSE DR SUITE 104
VISTA CA
92081-6642
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-940-4055
  • Fax: 760-940-4084
Mailing address:
  • Phone: 858-554-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA89574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: