Healthcare Provider Details

I. General information

NPI: 1598004954
Provider Name (Legal Business Name): MR. PAUL JOSEPH HONGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 05/14/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 TENNYSON ST # 12375
DENVER CO
80212-4415
US

IV. Provider business mailing address

3700 TENNYSON ST UNIT 12375
DENVER CO
80212-4415
US

V. Phone/Fax

Practice location:
  • Phone: 720-305-6689
  • Fax: 720-358-5897
Mailing address:
  • Phone: 720-305-6689
  • Fax: 720-358-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6633
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: